Autism Spectrum Disorder: Best Practices in Screening, Referral and Behavioral Health Interventions

Summary

In an informative session, Michigan AHEC explored the critical aspects of Autism Spectrum Disorder, focusing on early screening, diagnosis, and intervention strategies. The session addressed the increased prevalence of autism and the need for early intervention to reduce long-term care costs. It covered tools like M-CHAT for early detection and emphasized a multidisciplinary approach to diagnosis and treatment. Applied Behavior Analysis (ABA) was highlighted as an effective treatment method, and the importance of parental support and education for successful outcomes was discussed.

Highlights

• The prevalence of ASD has grown by 119% since 2000, underscoring the need for early screenings. 📊
• Different screening tools, like M-CHAT for young children and ASSQ for older ones, facilitate early detection. 🛠️
• Applied Behavior Analysis (ABA) is the gold standard for ASD treatment, focusing on behavior modification. 🧩
• The session emphasizes the economic impact of early ASD intervention, potentially saving billions. 💰
• Diagnosing ASD involves a multidisciplinary approach, integrating insights from neurologists, psychologists, and speech therapists. 📚

Key Takeaways

• Early screening using tools like M-CHAT is vital in identifying autism in children for timely intervention. 🔍
• The prevalence of autism has significantly increased, highlighting the need for awareness and early diagnosis. 📈
• Understanding the roles of different professionals, including psychologists and neurologists, helps in comprehensive ASD care. 🧠
• Applied Behavior Analysis (ABA) remains the gold standard in autism treatment, aiming to improve adaptive behaviors. 🏆
• Parental involvement and education are crucial for the successful implementation of ASD treatment plans. 👪

Overview

The insightful session conducted by Michigan AHEC delved into the complexities of Autism Spectrum Disorder (ASD) and emphasized best practices for screening, referral, and behavioral health interventions. Understanding these processes ensures early identification and intervention, which is crucial for the effective management of autism.

The discussion highlighted various screening tools like M-CHAT and the Autism Spectrum Screening Questionnaire, essential for different age groups to catch early signs of ASD. The necessity of a multidisciplinary approach in diagnosis and treatment was underlined, emphasizing collaboration among neurologists, psychologists, and speech therapists.

Applied Behavior Analysis (ABA) was presented as the gold standard for treating ASD, aiming to enhance adaptive behaviors and communication while reducing problem behaviors. The session also stressed the importance of parental involvement and navigating systemic barriers to ensure comprehensive care for affected children.

Chapters

• 00:00 - 00:30: Introduction and Overview The chapter 'Introduction and Overview' begins with an expression of gratitude to the audience for attending a session aimed at discussing an important issue. The speaker identifies as the principal investigator of a grant from the state of Michigan, which focuses on increasing community education about autism, specifically early screening, diagnosis, and referral. The chapter also notes the approval of CMEs or CES by Wayne State University for this educational effort.
• 00:30 - 01:00: Activity Requirements The chapter titled 'Activity Requirements' emphasizes the necessity for activities to be fair, balanced, and free of commercial bias. It is highlighted that all information presented is backed by scientific evidence, indicating approval to proceed with such content. The focus is on identifying autism symptoms and exploring various screening tools, including the M-CHAT and an online tool for assessing children.
• 01:00 - 01:30: Identifying and Screening for Autism In the chapter titled "Identifying and Screening for Autism," the focus is on understanding the difference between screening and assessment for Autism Spectrum Disorder (ASD). It aims to provide a general understanding of these processes. Additionally, the chapter discusses Applied Behavior Analysis (ABA), which is an evidence-based treatment for children with autism. The chapter also explores how to get individuals enrolled in ABA services and discusses the various roles involved in these processes.
• 01:30 - 02:00: Social Skills in Autism The chapter "Social Skills in Autism" emphasizes the complexity of autism spectrum disorder (ASD) and the necessity of a collaborative approach in treatment. It highlights the importance of understanding the roles and responsibilities of each member of the treatment team. Additionally, the chapter discusses recent changes in the prevalence of autism among children.
• 02:00 - 02:30: Communication in Autism This chapter discusses the increasing prevalence of autism diagnoses among live births. In 2000, autism was diagnosed in 1 out of every 150 live births, but recent figures indicate this has increased significantly to affect about 1% of the population. The chapter highlights the notable upward trend in autism diagnoses over recent years.
• 02:30 - 03:00: Repetitive Behaviors and Sensory Responses In this chapter, the focus is on the prevalence and importance of early detection of repetitive behaviors and sensory responses, which occur in approximately 1 in 168 births. The chapter highlights the necessity of early intervention and screening, not only for the benefit of the children and families affected but also due to the significant cost savings it offers. Emphasis is placed on ensuring that various individuals who interact with children are knowledgeable and equipped to address these issues effectively.
• 03:00 - 03:30: Screening Tools for Autism This chapter highlights the significant cost disparity in providing services for adults versus children with autism. It emphasizes the urgency of early detection and intervention for children to not only provide better outcomes but also to manage economic resources more efficiently. The financial implications outlined include an annual expenditure of $175 to $196 billion for adults, compared to $61 to $66 billion for children, underscoring the importance of early screening and intervention for autism.
• 03:30 - 04:00: M-CHAT and ASQ The chapter discusses the growing prevalence of autism and the importance of early screening, diagnosis, and referral to effective evidence-based treatment. It is noted that with the increase in prevalence, without proper intervention, there will be a significant rise in the number of adults with autism. The chapter explores whether the increased prevalence is due to an actual rise in cases or simply better screening practices, suggesting that it's likely a combination of both.
• 04:00 - 04:30: Diagnosis and Evaluation Process The chapter discusses the process of diagnosis and evaluation in the context of autism. It acknowledges the increase in early screening and diagnosis of children, noting that while more children are being identified with autism earlier, the underlying causes for the increase in diagnosed cases remain unclear. The chapter highlights the ongoing research efforts to understand the reasons behind these trends.
• 04:30 - 05:00: Applied Behavior Analysis (ABA) The chapter titled 'Applied Behavior Analysis (ABA)' discusses the significance of early identification of children with autism. While the causes of autism are not thoroughly explored or understood, the focus is on the economic benefits of early diagnosis. By identifying children with autism early, significant cost savings can be achieved, potentially reducing expenses by up to one-third of what might be spent on adults with autism.
• 05:00 - 05:30: ABA for Different Ages and Skills The chapter 'ABA for Different Ages and Skills' begins by emphasizing the importance of early treatment for autism. It aims to familiarize the audience with autism by discussing its diagnosis and the symptoms associated with it. Autism is described as a neural behavioral syndrome linked closely to neurology, and it is noted that many children with autism may have additional disorders.
• 05:30 - 06:00: Coordination of Care and Resources This chapter discusses the importance of coordination of care and resources for individuals with neurological issues, specifically autism. It emphasizes a multi-disciplinary approach, ensuring that medical professionals are involved in the care process. Symptoms of autism typically appear within the first three years of life, although many parents notice signs earlier. The chapter also mentions the availability of tools for early identification of autism symptoms and outlines two general categories used in diagnosing autism.
• 06:00 - 06:30: Parent Perspective and Challenges The chapter discusses the core symptoms of autism, often referred to as a 'Triad' of autism symptoms. These include impairments in social communication, repetitive and restrictive behaviors, and significant impacts on social interaction abilities. The text indicates that these are primary challenges faced by children with autism. The chapter aims to elaborate on these symptoms and encourages readers to understand these areas as key aspects of autism.
• 06:30 - 07:00: Overcoming Barriers to Treatment The chapter 'Overcoming Barriers to Treatment' focuses on the behavioral impairments seen in children with autism, and how these may differ from those observed in other developmental disabilities. It aims to conceptualize these differences, starting with an emphasis on social skills. The text discusses typical child development and emphasizes the importance of social interaction.
• 07:00 - 07:30: Summary and Closing Remarks The chapter "Summary and Closing Remarks" focuses on the behavioral characteristics of children with autism, particularly their interactions with their environment. It emphasizes the variation in behaviors among children with autism, such as differing levels of eye contact and varying responses to physical affection like being held. It also highlights the lack of reciprocal interaction typically observed through smiles and tickles. The discussion is based on observations and reports from parents, underscoring common traits in early development that may indicate autism. The chapter closes by urging attention to these signs as part of understanding and supporting children with autism.

Autism Spectrum Disorder: Best Practices in Screening, Referral and Behavioral Health Interventions Transcription

• 00:00 - 00:30 so um thanks so much for coming out this morning I'm really excited that I get a chance to talk to you guys about a really important issue um I am the principal investigator from a grant that we received from um the state of Michigan to try to educate people out in the community a little bit more about autism early screening diagnosis and referral so I appreciate you all coming out um just to get us started um for anybody who's getting CMEs or CES um this has been approved by Wayne State un University and in order to do that um
• 00:30 - 01:00 all of these activities have to be fair balanced and free of commercial bias and also um all of the information that you see today will be fully supported by scientific evidence so I just wanted to inform you that we have been approved um to do that um what we're going to do today is we're going to focus on identifying um symptoms of autism we're also going to look at some different screening tools including the mchat and uh and another screening tool available online for children who are a little bit
• 01:00 - 01:30 older um we're going to look at a little bit um of information on assessment and talk about the difference between screening and assessment for ASD um hopefully by the time you guys are done you'll have a general understanding of what it takes to do that and then also we're going to talk a little bit about ply Behavior Analysis which is an evidence-based treatment for children with autism and you'll have some background on what that is and also how to get folks enrolled into that particular type of service and then we're going to talk a little bit about some of the different different roles
• 01:30 - 02:00 and responsibilities of people on the treatment team um autism spectrum disorder really is um a very complicated disorder and it takes a lot of different people working together so we're going to talk a little bit about the roles and responsibilities of all the people involved just to get us started though um I think it's important to talk a little bit about why we're focusing on autism and some of the changes that have taken place in the population uh currently children with autism um the it occurs in about one out of 68 of every
• 02:00 - 02:30 live births and that is really about 1% of the population currently it has grown tremendously in the last few years um we've definitely been on an upward trend for quite some time if you um if you look at the amount of children who are diagnosed with autism just in 2000 um that was occurring at that point one in 150 live births and now we have increased um 100
• 02:30 - 03:00 19% up to one in 168 births and that's really important because um we need to make sure that we're catching kids early because it is happening so frequently we need to make sure that a lot of different people who touch children are available and understand what this is so that we can really focus on um early intervention and screening one of the main reasons why we want to focus on that is because not only does it help the child and the family but it also is a tremendous cost saving for um for our
• 03:00 - 03:30 government and for the community it costs quite a bit more to provide services for adults with autism than it does for children with autism so it's really important that we get going right away and we really focus on catching kids as early as possible it could cost um anywhere from 175 to $196 billion dollar for our country to treat adults with autism where for children it costs more along the lines of 61 to 66 bill ion dollar so that's definitely a huge
• 03:30 - 04:00 difference and with the increase in prevalence we're looking at over time if we don't do a lot with early screening diagnosis and referral into effective evidence-based treatment we will at some point have a lot more adults with autism than we do now so just as the prevalence is is growing we can do a lot for early intervention and treatment yes sir is the prevalence growing or is it because there's more screening so I think it's a combination of the those kinds of things
• 04:00 - 04:30 um I am not an expert in the difference between you know what's happening out in the community and what all the different theories are um there's a lot of things out there but the evidence does show that there are some changes on both ends so there are more children who are being screened and diagnosed early but also there are still more children in the population with autism but the reason why isn't really something that people have um identified a cause for so there are a lot of research scientists that
• 04:30 - 05:00 are looking into causes of autism but that's not something that I'm really prepared to discuss right now um and there are a lot of people that really just don't have a good solid answer even though there are a lot of theories so our goal is if we can like I said identify children early we can have a cost Savings of up to one point or up to onethird of what we may have um spent on adults with autism we can have a cost-saving by identifying children and
• 05:00 - 05:30 treating them early and we'll talk a little bit about what those treatments look like um as we go forward so the next thing that I want to do is I really just want to acclimate everybody to what autism is and we're going to spend a little bit of time talking about the diagnosis and some of the symptoms that you might see if you see children with autism but just to get us started um autism is a neural behavioral syndrome so I'm very closely tied to neurology a lot of kids with autism also have other
• 05:30 - 06:00 neurological issues so that's one of the areas that we work in a multi-disciplinary way making sure that we're connecting with our medical professionals as well um symptoms are going to occur within the first three years of life although many parents report that they see the symptoms of autism much earlier and there are a lot of tools which we will talk about that can identify symptoms at a much earlier rate um there are two general um General categories that we're looking for when we're diagnosed ing autism and those are
• 06:00 - 06:30 social impair social communication impairments and repetitive and restrictive uh stereotype behaviors so I'm going to talk a little bit about what each of those mean but what I want you to do is really Envision basically a Triad of autism symptoms so we're looking at impairments in areas of social interaction which is one of the primary um difficulties that children with autism have we're also looking at different impairments in communication and then looking at some very specific
• 06:30 - 07:00 behavioral impairments that children with autism have that may be different than it um behavioral impairments that you might see with other developmental disabilities so that's how we're going to conceptualize that and we're going to talk a little bit about what each of those areas means so um the first thing we're going to focus on is social skills so you may know a lot about typical development I'm hoping that you guys at least um all have uh that reference point but in typical development kids are really focused on on um interacting
• 07:00 - 07:30 with their environment in a very seamless way um children with autism differ pretty considerably in their ability to attend the things that you might notice early on that parents tend to report could be a lack of eye contact many kids are resistant but not all are resistant to being held um there's a there's not a reciprocal kind of interaction between smiles and um tickles and those kinds of things that you may not see if you do see it you may
• 07:30 - 08:00 not see it at a at a high enough rate that you would see in typical development there's a lack of other types of social interaction like joint attention like pointing those types of things that you wouldn't see um kids that are talking you may be able to speak with them and I'll talk a little bit about Communication in a minute but their communication skills do not have as much of a social component So when you say something to them they may not understand the social reference to it so
• 08:00 - 08:30 for example um many kids won't interpret they'll interpret language very literally so if you say your mom's got eyes in the back of her head they may not understand that that means that your mom is watching you at all times they may literally think oh what do you mean she has eyes in the back of her head and then become very confused and that's not necessarily a communication issue that's a lack of social skills and perspective taking so um things like rules things like social behaviors that can be very difficult for children with
• 08:30 - 09:00 autism the idea of perspective taking is very closely related to theory of mind is anybody familiar with the concept of theory of mind so really understanding that I can think one way and somebody else can think a different way and that has a lot to do with some of those early deficits so kids don't attend to the social World they don't attend to their environment very well they have a really hard time predicting behavior of other people and that's really at the heart of what makes autism different than some of these other things because they have
• 09:00 - 09:30 those issues that really affects their ability to understand and use facial expressions it really um makes it difficult to have a variety of social interactions their play looks very different sorry about that um they have a difficult time with groups so it's difficult for them to manage that or navigate those kinds of situations and um also other kinds of things may pop out when they're in these social situations you may see behavior problems you may see anxiety you may see some
• 09:30 - 10:00 other kinds of things because they don't have the skills they don't have the social skills to be able to appropriately interact so some of these other things that make autism look more apparent out in public can really be related to some of these core skill deficits that that they uh really lack in Social in the social area so what we're going to do next is I'm going to play a video for you you're going to observe um two children that are playing one child has autism and the other child does not you'll notice that it's the younger child that does not have autism
• 10:00 - 10:30 and what I want you to do is um if you have uh someplace to take notes so you guys have some uh information packets if you could as you're watching the video maybe jot down a few things looking at the social skills that we just talked about to see if you can recognize some of those things um in the child with autism
• 10:30 - 11:00 what you doing Jackson
• 11:00 - 11:30 you with some pegs
• 11:30 - 12:00 with some PS so in that video hopefully you were able to see a few things that you could recognize from the slide before did anybody notice the difference between the two children in their
• 12:00 - 12:30 sorry about that in the eye contact that they were making with the person who was videoing I think that was their their father did anybody notice the difference so Jackson had a much different um response to the father's voice you noticed when Juliet was playing with what um she was doing the father started to talk he said something I don't remember what he said but as soon as he said something she immediately referenced him she looked right up Jackson didn't look at all any
• 12:30 - 13:00 differently than he did as if nobody was else nobody else was in the room she had um also taken her little block and kind of you know showed it to her dad a little bit you know like hey look at what I have made some Smiles those kinds of things so and she was a much younger child than the other child was as well so you can really see the difference between development of social skills in that particular video the boy didn't really make eye contact he didn't really see to change his behavior or adjust
• 13:00 - 13:30 anything he didn't try to engage with his sister at all either which is also um something that you would notice from children with autism so even though they're sitting and doing parallel play typically kids will somewhat engage with each other whether it's showing or talking or you know trying to grab the other person's toy so there really wasn't any of that as well so those are some of the things that um that you might see as differences between a child with autism and a typically developing child so hopefully these were some of
• 13:30 - 14:00 the things that you wrote down po poor eye contact lack of response lack of initiation not referencing not trying to share not pointing those kinds of things so the next area that we're going to focus on is qualitative impairment and communication so we focused on the social skills aspect and it's really hard to intertwine some of these things because social and communication really go hand inand but when you're thinking about about communication some children
• 14:00 - 14:30 with autism are completely non-verbal so that's very easy to tell obviously they have a lack of communication skills if they don't speak but some children with autism do speak and then you have to look at not just the amount of speech that they have but what is the quality of their speech and when you think about that you're looking at things like um how rote is it how um big is their vocabulary and how do they actually use their speech so those are some of the things that you might um notice a typically developing child
• 14:30 - 15:00 is going to have a lot more skills in um things like responding I'm going to come back to this slide they're going to respond to sounds in the environment they're going to respond to when people talk to them they're going to be able to engage in conversations they're going to be able to um engage in communication type activities while they're in play so you might see a child engaged with some some sort of a theme play and they might
• 15:00 - 15:30 be having the characters talk those types of things um you also have this listener speaker response and it's fairly reciprocal when you're in a conversation you're going to be able to make sure that you're checking in with the listener not just talking over them or not just talking about a certain topic and these are some of the things that we notice with children with autism so sometimes they have a really good vocabulary but their vocab isn't really isn't really flexible so
• 15:30 - 16:00 you might notice a child um sometimes they'll have something what we call echolalia and echolalia is a a repeating of something that's already heard but it doesn't have a functional communicative intent so you might hear a child um saying something after you say something so you would say hi Johnny how are you today and they would say hi Johnny how are you today so they have the speech they have the ability to communicate but when they use those words it isn't as
• 16:00 - 16:30 meaningful as it would be if you were working or talking with a typical child some other children also will have similar what we call scripted Behavior with their speech and they may you may see kids that watch movies and then they'll talk out the whole movie they can act it out they can even take their toys and they can and it looks very much like play it looks very much like theme play but none of it is novel none of it is spontaneous none of it is their own it's all plucked from somewhere else so
• 16:30 - 17:00 those are some of the differences that you might see just in the in the communication area and that's a little bit different than social like I said it kind of overlaps a lot and the DSM just changed recently it used to be social and communication were separate but now they really combine those into one area because it's really difficult to tease some of those PE pieces out so just looking at typical development also by the time a child is 15 months old they're going to have two-word phrase or they're going to have um at least single words and by the time they're 24 months
• 17:00 - 17:30 old they're going to have probably two-word phrases so this is a really key piece if these things are absent in a young child that's a a red flag for the fact that maybe you need to look at them for autism or some other developmental disability the echolalia or the Partin or the scripting behavior that I was talking about that's another big red flag if kids are just directly repeating what you're saying and they're not initiating conversation or their conversation seems to be very rot or
• 17:30 - 18:00 repetitive another key thing is sometimes kids will use almost a madeup speech they'll have words that mean something very specific to them but they don't mean anything to somebody else and you almost have to learn their own language that would be something else that would be present in autism that you wouldn't see in typical behavior um so like I said it's not just that the kids don't have language or it's not always that their language is delayed but it might also be the fact that it's just
• 18:00 - 18:30 oddd or it's not used in the same communicative way as um it is typically so we're going to do the same thing I want you to take a look at this video our goal for this video is communication so I want you to look at the communication skills of this child and I want you to also evaluate what you see here and if you see any of the things that we were talking about
• 18:30 - 19:00 [Music] hello are you how's it going what you doing today you do [Music]
• 19:00 - 19:30 okay talk to you later okay hello hello talk to you later byebye goodbye the [Music] phone so what did you notice in this
• 19:30 - 20:00 video anybody notice anything specific in this video based on what we talked about in the other slides he repe everything that she said he repeated everything that she said exactly so the the language wasn't he didn't expand he didn't engage really it was more of a mimic or a Partin although it was a very social situation he was having a good time she was having a good time so kids with autism are not necessarily that kid in the Corner sitting and rocking they can be somewhat
• 20:00 - 20:30 socially engaged it's just the quality of that is going to be different than what you would see in a typical child so he had um I think she said hello he said hello which seems very natural but then when it moved on it got a little deeper she said a couple of things he mimicked them back or maybe he went back to like the beginning of the script she was trying to hang up the phone and move on to the next thing and he went back to hello hello not really following the interaction like a typical child would so those are the things that you might
• 20:30 - 21:00 see with a child with autism and I use this example because I think a lot of people get confused when they do see language that well he's talking he's engaging he must not have autism but it's really the quality of those kinds of things that are important [Music] so when thinking about and this is this is pretty much what we just um went through his language really didn't have communicative intent and he couldn't continue the reciprocation piece of of the conversation so the next area that we're
• 21:00 - 21:30 really going to focus on is um the behavioral section so kids with autism do have a very specific um behavioral deficit and that has to do with restrictive repetitive and stereotyped patterns of behavior interest and activity so sometimes kids with autism will have um movements that are odd and I think most people are familiar with those kinds of things so you may see things like rocking you may
• 21:30 - 22:00 see spinning you might see like odd finger movements and poses those types of things I think most people are familiar with with autism but sometimes this stuff comes out in a little bit of a different way so maybe they will only play with a certain type of toy maybe they will only watch SpongeBob maybe they will only engage in a certain way um you also might notice that their toy play might o be very repetitive so just
• 22:00 - 22:30 like they had I I talked about the scripting they may play with toys but it's the same scenario over and over again they take the truck and they move it in this way it goes to the top of the ramp and then they watch it go down those are the types of things that you might see with children with autism they also tend to have um a really narrow range of Interest so um sometimes with higher functioning kids they may only talk about certain topics or they may listen to you for about half a second if you're talking about something something but then they switch it back to whatever
• 22:30 - 23:00 their interest is so whether it's you know um what kind of model make and color your car is or you know stop signs and planes or different things like that they may be very hyperfocused on certain areas so the kinds of things um like I said that you might notice in addition to that would be odd responses to stimuli in the environment so a child with autism they may have a different response to smell or sight or sound or
• 23:00 - 23:30 pain than other kids might have so some examples of this would be the child who hears the lights like um if you ever go through the store and you have the fluorescent lights and they kind of buzz and that that's really bothersome to them or um there was a child that I knew that um you know he would walk into like a restaurant or Dunkin Donuts and the smell of bagels made him nauseous so he like had to leave and vomit um other kinds of things that you might notice is kids might be really sensitive to their
• 23:30 - 24:00 clothing or to touch or to certain kinds of things sometimes you get the complete opposite effect they seem like they don't even register anything at all so it's not just over sensitivity to sensory stimuli but it might be a lack of sensitivity to sensory stimuli and not attending to those things so sometimes you might see that um um they kind of have tunnel vision and like they're looking here but something that happens they may not catch something over here that maybe somebody walks into the room or something like that and they wouldn't notice those kinds of things
• 24:00 - 24:30 and that kind of goes along with also the sensitivity to pain some kids with autism their parents report they they get hurt and they don't really have any kind of a response they don't seek Comfort they don't cry they know that it hurts they fell down they got a big egg on their head but it's not really um registering with them to do any of those things and this stuff is is related to two core skills it's related to attending which is a huge deficit for kids with autism and it's it's also related to social skills so if you think
• 24:30 - 25:00 about pain we may feel pain but we may respond to pain differently right and mostly when you're seeking comfort from someone that's a very social kind of Engagement so I would say that it's not that they don't feel these things all the time but how they attend to them and also how they respond to them are going to be different than what we may do so we may we may respond to them differently than we may see from a child with autism so we're g to watch another
• 25:00 - 25:30 video this is the last video that we're going to watch of this type and what you're going to be looking for in this video is a behavioral skill deficit so you're going to be looking for how this child responds behaviorally to the environment that she's in
• 25:30 - 26:00 oh you're welcome
• 26:00 - 26:30 [Music] s put it all than
• 26:30 - 27:00 s it's okay can can I see this one
• 27:00 - 27:30 you going to get it yeah I'll take a pause while you get it so what kinds of things did you see in this video anything that was Salient to you she got upset every time M thank you so she got upset every time that the cup tipped over so you might
• 27:30 - 28:00 have noticed she was try she had a very specific goal and the goal was a little odd right it wasn't the way that people typically play with cups and saucers and dishes so typically a girl that age is going to be having a tea party she's going to be sharing she's going to be doing those kinds of things so she had a really different agenda with those toys but when it didn't work out quite the way that she had hoped there was also this behavioral response so you probably noticed the repetitive Behavior right you probably notice the odd
• 28:00 - 28:30 behavior associated with that and then also this um this very specific response I don't know if anybody picked up on this but she when when something didn't go her way she flipped right into this odd whining behavior and then when something got fixed she shut it right back off so like typically a child if they're upset they're upset they're going to be upset for a second but it was really um two different conditions almost for her and it was very easy for her to go back and forth which is kind of an odd soci social response as well so um that was very different for a
• 28:30 - 29:00 child that age she's probably 4ish and you might be able to kind of empathize with the parents also that has to be extremely frustrating to try to engage with a child and not be able to predict like when she's going to be really upset so that can be really Troublesome to um to parents and professionals who are working with children but that's just one example of what you might notice um with a child with autism so now that we kind of have an
• 29:00 - 29:30 understanding of some of the things that you might be looking for to try to identify within kids with autism now we're going to talk a little bit about how do we go about doing that in in more of a clinical way so rather than just kind of eyeballing it you know and going you know that kid probably has autism based on those kinds of things there are actually some screening tools that we're going to talk about in order to um to better make some um uh referrals to get a diagnosis so the autism or I'm sorry
• 29:30 - 30:00 the American Academy of pediatric pediatricians recommends that we are um doing a survey of autism at each developmental visit so they want you to do both developmental screenings and they also want you to scream for autism particularly at the 18month and the 30 or 24mth depending on when the kids are coming in but that's kind of the key time where we're really looking to try to identify kids with autism most parents at that point know that there's
• 30:00 - 30:30 a problem with their child or they have some concerns or some of the things that you're going to observe are going to be pretty apparent and you are likely to see them in a even in a short office visit so that's kind of the goal with that and we're going to talk a little bit about the M chat and I do want to say that we're going to talk about diagnosis in a few minutes but the screening tools are very different than the diagnostic procedure the screeners are really to um over identify because
• 30:30 - 31:00 we want to make sure that we catch everybody and then a lot of times when they get to the actual diagnostic tools those kids may be ruled out but it's important that even if you have a sneaking suspicion based on the scores for the mchat or some other type of um diagnostic screener that you are referring them for a diagnosis because the goal is not that that you're telling the parent that the child has this particular disability but that you're going to um talk to professionals that
• 31:00 - 31:30 are more experienced in the area of doing diagnosis so that you can make sure that that they do or that they don't um that's really the most important thing so we're going to talk about the mchat as a screening tool the M chat is very easy to use it's actually available for free online we'll take a look at it in just a minute it's a total of 23 yes and no questions the measure itself focuses on that Triad that we talked about so the questions are reflected of social questions
• 31:30 - 32:00 communication questions and behavioral questions to try to pull for those types of um behaviors that may be happening in the environment um you can use it for kids from 18 months to four years of age um it detects ASD it could also detect other language impairments or um me mental retardation or cognitive impairment so kids who score high on this may not end up having autism they may end up having a speech and language impairment or they may have an alternative cognitive impairment um as I
• 32:00 - 32:30 said it's a screener tool so it's overly sensitive you're going to get a lot more false positives and then later on the diagnostic tools are going to then rule those kids out and be more specific in the diagnosis so if you look at the M chat um we're going to look at that in just a second but if you um score on more than two critical items or any three items that are failed you're going to um pretty much say these kids probably need
• 32:30 - 33:00 to go and and have a referral the nice thing about this is I'm just going to show you a few of the questions but in the same um document on the same web page you can um also get information on scoring um they have a lot of other tools the mchat has actually been published in several different languages and there's a lot of information online about how this has been used so I'm going to go right now to the M chat online so that we can take a
• 33:00 - 33:30 look at what some of those questions are oh no I'm sorry that's not what I wanted to go to also not what I wanted to go to okay okay sorry about this
• 33:30 - 34:00 there it is okay so here's an example of some of the questions as I said they're all yes and no questions so you might read something like does your child pretend play or make belief so that's going to come from that social area right where the child is not really engaging they're not using their communication during play um does your child point with one finger and ask for some someone or
• 34:00 - 34:30 something to get help so they're going to point as a way to communicate with you and a lot of kids with autism are not attempting to communicate with you so that's a big red flag um you might also see on here is your child interested in other children so that's a they should be looking at children they should be approaching children those kinds of things um does your child get upset by everyday noises that would be an example of something that would come from that behavioral repertoire that we talked about and then there's some other
• 34:30 - 35:00 things like just uh General developmental things so like does your child walk most children with autism are not going to have significant um gross motor impairments so that would kind of rule out maybe that there's some other type of a problem if the child is is not walking so um that's an example and then let me go back to our PowerPoint
• 35:00 - 35:30 actually what I'm going to show you now is a video of somebody administering the M chat in a interview form so we'll watch just a couple minutes of this she has a 2-year-old son Grant and we're going to do the inart revised if you point it across the room will grant look at it and follow your
• 35:30 - 36:00 point how would he respond if you point at something would he would he point to it would he look at the object would he look and comment on the object would he look at you say look and
• 36:00 - 36:30 it have you ever wondered if Grant might be de that was one the um does Grant pretend or make believe
• 36:30 - 37:00 like would he pretend to drink from a cup or answer the telephone now I'm just going to give you a list of things and you just tell me if he would or wouldn't do any of these things would he you said he wouldn't drink from a cup would he eat from a toy spoon or would he pretend to talk on the telephone would he pretend to feed a dollar
• 37:00 - 37:30 animal would he push a car if it were going on the [Music] road would he ever pretend to be like a robot an airplane a ballerina or any
• 37:30 - 38:00 sort of character or anything would he put a toy pot on the pretend stove would he stir imaginary food would he put an action figure or a doll into a [Music] car so I'm going to go ahead and stop it obviously you guys have access to this it's free this is online if you want to watch the whole thing or if you want to just read through the screening tool yourself um these are all the questions
• 38:00 - 38:30 directly from there um this is being done in an interview fashion this isn't always the way that the M chat is done you could do it in an interview fashion if you did this you might get some more information some more description about what they might mean you might be able to score it more accurately to determine sometimes parents will misinterpret the questions and they'll say like um for the question that she was kind of considering with the toy truck where um he did play with cars but not necessarily in the fashion that they
• 38:30 - 39:00 were looking for so you might see with some of these kids that have scripted Behavior or they may push something in a rote way and the parents May interpret that as more thematic play so it's helpful to if you do something like this to get a few more questions about can you give me an example or what do you mean that obviously is going to take more time so that um type of an assessment probably wouldn't be done in a doctor's office because you may not have that kind of time in addition to everything else but in other kinds of settings like potentially in a school
• 39:00 - 39:30 setting or maybe in more of a clinical setting um where kids are maybe being evaluated for um services or things like that and trying to figure out do they meet the the criteria for autism that might be something where you have the time to do something like that because then you would have an opportunity to talk a little bit more with the parents about that but that's just an example of the type of thing that you might see if you were going to do the M chat
• 39:30 - 40:00 oops did I lose my PowerPoint there it is okay so you guys all have a copy of this so um you can look at what those references are you can go online and see other langu is that the mchat has been translated in um first signs.org is a
• 40:00 - 40:30 nice reference for people that um just are looking for a variety of different resources and tools for this type of thing so you might want to check that out and then also um our video that we just played is also on there if you guys want to go back and take a look the next thing that we are going to look at is we're going to look at a screening tool for children who are a little bit older so this
• 40:30 - 41:00 oops all right so this is the um autism spectrum screening questionnaire so you would use this tool for children who are between um ages of seven and 16 the reason why I put this one on there is because this is also free there are several other screening tools that are available sometimes you have to have um a master's degree in Psychology or or some other kind of criteria to purchase
• 41:00 - 41:30 them and they are fairly expensive but as a screening tool if you were just looking for something that's um easy to get access to this is the same kind of thing as the mchat but it's um something that's available for kids who are a little bit older this is on a three-point scale and it ranges from um scores of 0 to 54 if you score on 19 or higher then that would indicate that there might be um autism in this child so same kinds of things but you might have um on this one you're going to have
• 41:30 - 42:00 a little bit more with language because at that point the child's language would probably be more developed so you might see um has a deviant style of communication with formal fussy old-fashioned or robotic like language again those kind of come from those social skills areas um idiosyncratic words or Expressions um this we didn't talk about but has a different voice or speech you might notice that a child with autism has a different tone or a different Rhythm than typically um this
• 42:00 - 42:30 one is a good one for social um usually um uses language freely but fails to make adjustments for um social context so you might talk one way to your grandmother and you might talk a very different way to your friends and kids with autism may not adjust for that they also don't tend to adjust for distance so if I'm going to talk and make sure that you guys hear me in the back I'm going to use a much higher voice a Lou voice than if I'm talking maybe um
• 42:30 - 43:00 sitting next to my husband having an intimate dinner at a restaurant I'm going to use a much lower voice so their voice may not modulate for distance and social situations so again you can read through this and you can see what that is but that is again just another tool that you can use to look at ASD um in older children and it's likely that kids who are a little bit older could have been missed for ASD we're really focusing on screening and doing early diagnosis but one thing that you may or
• 43:00 - 43:30 may not know is that insurance coverage for autism is something that has happened recently in this state and PRI prior to that a lot of kids there wasn't a really big need for them to get a formal diagnosis so they might have gotten Services maybe um because they have a developmental disability but not specifically identified as autism so you could very well have kids who although they've had autism their whole life since they were three they've had had these symptoms but maybe they kind of fell through the cracks with getting a
• 43:30 - 44:00 diagnosis and now in order to get access to additional Services we need to give them a diagnosis for the first time even though they're older so it is important that we use those types of um tools as well okay so that uh slide talks about the things that that I mentioned why we were looking at that so now that we kind of went over that what what do you do with this information and and I think that the
• 44:00 - 44:30 most important thing for everybody at this point to think about is what kind of contact do you have with kids at what age do you have contact with kids and then how can you incorporate some of these things some of these tools into your current practice you know maybe you don't have time to do an interview but could you maybe while the child is sitting in waiting for an appointment in your office could you hand the parents an mchat could you hand them a screener so that they could at least go through that could you collect some of that information from them in a different way
• 44:30 - 45:00 who in your office or in your practice might be the person to do this it's going to be different depending on your setting is it going to be you is it going to be maybe um somebody else maybe the office secretary maybe um somebody else that works with you so it's really important to think about how is this going to happen the next thing to think about and one of the barriers I think that um parents come into contact with is once they get a positive screen how does that professional respond to them
• 45:00 - 45:30 because I think it's really important for you to be able to give them that information in a very confident way and it's okay to tell them that yes you your child did have a positive screen but we may need to take it to that next step and it's very important that you get your child to The Next Step there's sometimes a delay some parents are really comfortable they knew that there was always something wrong with their child some parents are not some parents par are not ready and they need that little extra nudge to get them to the
• 45:30 - 46:00 next step and it's very important for you guys as professionals to be the person that gets them to the next step because they're already in their office which already in your office which means that you already have a relationship with them and if you have a relationship with them they are more likely to trust you and follow your direction so I think it's very important that this becomes something that you're really confident in and you can kind of know enough about this so that you can get that to The Next Step so if you're not comfortable
• 46:00 - 46:30 with that then all of the resources that are here and there are lots of other things on the internet that you can look at to try to become more comfortable so that way you can really um give this information to families with conviction so as I said you are sometimes the only person or the very first person that's had this conversation with people so I think it's really important to guide them one of the other things that we're going to talk about is the time delay between
• 46:30 - 47:00 when people get a diagnos or when they get a referral and then when they get a diagnosis so they may have a positive screen but it may take them up to 16 months before they actually get to the point where they get a diagnosis that could potentially be speeded up there are some roadblocks to that because it may take some time before they can get appointments with the appropriate professionals but sometimes the delay is in the the parents not being sure or being afraid to take the next step so I
• 47:00 - 47:30 think it's really important that maybe you can also schedule a followup or do a follow-up phone call with people to check to make sure you got this information now what did you do with it and really helping them to educate educate them and understand what's out in their community and those are the things that we're going to talk about next so before we take our break I'm going to go through what the diagnostic evaluation process looks like and it's
• 47:30 - 48:00 something that you need a lot of um training in it's not something that everybody is going to learn how to do and probably most people in this room would not be responsible for doing Diagnostics but it is important for people who are doing early screening that they really understand the diagnostic process because honestly it can be very frustrating for families and it can seem very um cumbersome to kind of navigate through this and as professionals the more we know about these processes the easier we can um help the families really navigate so
• 48:00 - 48:30 getting a diagnosis for autism it it should happen in a multi-disciplinary way as I said there are um lots of different things that go into autism it's a fairly complex disorder um typically what you're looking for is the child is going to see a neurologist they're going to try to rule out any other neurological problems up to 25% of children with autism will also have some additional neurolog iCal issue tick seizures those types of things so it's
• 48:30 - 49:00 very important that they also get looked at by a medical professional um there may be other people that you need to look at as well kids with autism have a lot of cor comorbid difficulties in the medical Arena they have gastrointestinal problems they have sleeping problems they have feeding problems there's all kinds of things that could potentially be happening as well so if they need to be referred to those Services it's very important that they get there as well but at the bare minimum if they see a neurologist the neurologist is going to be able to do some physical exam with
• 49:00 - 49:30 them and they will be able to refer them on to those other places if necessary the the second prong is the psychological evaluation and that's where most of the diagnostic um testing that I'm going to talk about comes from um there are some real specific things that um you're going to do you're going to do what we um call the the which is the autism diagnostic observation schedule and there's some other autism specific evaluation tools that we're also going to talk talk about um we're going to be screening for some of those medical issues or other kinds of things
• 49:30 - 50:00 as well during your psychological evaluation and then the third prong of this is the speech and language evaluation and the diagnostic process is a little bit different depending on what mechanism you're trying to get people into for services so right now there are two main um Avenues to get service basically it's public insurance and private insurance so kids who have Medicaid may not have to go through all of these types of things however it is still recommended um particularly for
• 50:00 - 50:30 some of those medical components that they that we make sure that we look into that but in order to get access to treatment they don't need um the neurology and the speech and language they do need the psychology um to be able to do those specialized autism evaluations insurance companies private insurance companies um each of them are going to handle things a little bit differently but I put these three on here because Blue Cross and Blue shei Blue Cross Blue Shield has a very specific um Pathway to get into applied
• 50:30 - 51:00 Behavior Analysis services and you actually have to have all three of these in order to get a diagnosis to get access to applied Behavior Analysis services so they call it their multi-disciplinary team and there's actually a review process and there's only I believe right now in Michigan 12 sites that can actually they're authorized to do this type of an evaluation for Blue Blue Cross Blue Shield um I'm going to show you a slide later on that has a website that you can look
• 51:00 - 51:30 those up so that you guys can access that information as well but in order to get access to applied Behavior Analysis the neurologist the psychologist and the speech and language pathologist all have to agree that the child has autism they all have to have a discussion about that child and then sign off on this so one of the reasons I inform you guys about this is because that could take some time all of these professionals are very busy and it takes quite a bit of coordination to get them all in the same room together to have this discussion
• 51:30 - 52:00 and especially if we're trying to service all the children in the state who have Blue Cross Blue Shield and 12 sites that can be cumbersome as well so just to kind of think about what this process is if there's anything that you can do on your end to help the families navigate that whether it's having a relationship with the neurologist having a relationship with one of the sites that actually do these evaluations or following up making phone calls helping the families navigate the insurance company all of those things are really important so basically for the
• 52:00 - 52:30 diagnostic process we are looking at reviewing the history reviewing um medical evaluation um medical history we're doing some sort of a developmental interview so we need to speak with the parents we need to get their perspective what's been going on with this child um if they are a younger child it's sometimes easier because they have to recall just what's current if they're an older child sometimes that can be a little bit more difficult because we're recalling information from when they were younger because we have to to make sure that those um features of autism were um apparent between the ages of
• 52:30 - 53:00 three and five so that's that can sometimes be a challenge for older children but we're doing some sort of um parent interview we're also doing direct observation and we're going to talk specifically about the but the is a direct observation tool where you have a child in a room and you're doing some very specific activities with them which is different than a standardized tests and I'll explain that but you have to actually be working with the child um it's also really important that we get some cognitive assessment as well as um
• 53:00 - 53:30 try to assess how the child is um functioning adaptively in their environment and any other mental health um scenarios that may um complicate the issue to either rule out or rule in specific uh situations that may be comorbid so our parent or Guardian interview um what is recommended as the gold standard for this is called the autism diagnostic interview revised this particular um this particular assessment tool is a semi-structured tool and it is really
• 53:30 - 54:00 keyed for the DSM for but you're still going to get um accurate results with the new definition because as I said those things are just kind of combined at this point so they still have all of the same um features that you're looking for in order to administer this um it is recommended that you have considerable amount of training for this and one of the reasons is um although it is semi-structured there are some core questions that you're asking the families but a lot of times how you ask those questions can determine how the
• 54:00 - 54:30 parents answer so if you have a bias going in that you feel that your child should get a diagnosis of autism you may answer the questions in a very specific way if they're just written off the page or if they're just um read off the page for the parents because as a clinician you're looking for things but you want to have a conversation with the parents to try to um try to press them for very um specific examples and things like that so that you don't bias it and in the opposite direction some parents go in and they really do not believe that
• 54:30 - 55:00 their child has autism and they don't report some of those kinds of things so again really kind of digging and looking for that information and then scoring it appropriately um does take a little bit of training and it's important that you have inner rater reliability with other clinicians that are experienced not just in autism but also in administering this particular tool it takes between an hour and a half and 2 hours there are 93 items not all of them are scored so you don't have to actually administer all of them but um you do definitely need to get a good picture of all the things
• 55:00 - 55:30 that are going on and again there's that recollection for older kids of between the time that you're three and five and then um you're looking to um do this with a child who has at least the mental age of two so that is the parent interview and very similarly to the other things that we've been talking about it has um specific questions for repetitive behaviors communication deficits social interaction deficits and again um the age that those things may have manifested so those are really important um this is really good as a
• 55:30 - 56:00 tool because it gives you the opportunity to account for the all of the child's life so if they are older you can look back um it's also very comprehensive if you do an office visit you're not going to get the whole scope of what's going on with a child so this is really important and then um you also have the opportunity to use your clinical judgment in interpreting the parent report which can be really helpful um because sometimes as I said parents kind of come in with um sometimes their own biases on how um
• 56:00 - 56:30 they would like the evaluation to go however it can be very time consuming and it does um require some um training and then it is solely a caregiver report so you don't necessarily see the child in this situation and that's important to consider as well the direct observation tool is the diagnostic observ the autism diagnostic observation schedule this can be used with kids um actually at 18 months there's a toddler version now um all the way up to adulthood and this is the kit it's a lot
• 56:30 - 57:00 of stuff and the reason why there's so many things is because you are basically setting up situations for the child to engage in a variety of play activities and those are going to be very different depending on the age of the child there are five different modules um obviously 1 two 3 four and five they go um not just in order of age but also in skill so for example the difference between module 2 and three is how much speech they have so if a child is old enough to
• 57:00 - 57:30 have a certain amount of speech I'm sorry old enough to play with these types of toys they also have to either have phrase speech for module one I'm sorry module two or they have to have more fluent speech in order to participate in module 3 so as I said this is play based this is really so that you can observe social um interactions play gesture eye contact all of those things that you saw in the social and communication ranges as well
• 57:30 - 58:00 as in the behavioral range we're looking to not only um have parent report from that but we're also looking to see it for ourselves okay so I think at this point we're going to go ahead and take a pause for a 15minute break so feel free to get up and get Refreshments or use the restro and we will reconvene at 10:45 and we're going to get into the uh
• 58:00 - 58:30 referral portion so we're going to talk a little bit about applied Behavior Analysis and then um about the parent perspective before we end our session today so that's where I'm going to start actually before I do that we did have a question from Northern Michigan University the question was Will Blue Cross Blue Shield accept a psychiatrist referral so I think what this person was referring to is um in replace of the
• 58:30 - 59:00 neurologist um the Blue Cross Blue Shield um multi-disciplinary Team there can be a different Medical Professional so a psychiatrist could be the medical professional or sometimes an MD can take the place of a neurologist for that person um I do apologize for that our system we do use a neurologist but other systems they do use other um medical professionals so a psychiatrist can um sit in on that team as well if that's not the question because when you're talking about a referral this is
• 59:00 - 59:30 actually not a referral process this is um this the process for Blue Cross Blue Shield is two steps the first is the child has to receive a diagnosis and this um multidisiplinary team is set up for them to receive a diagnosis children with autism cannot get authorized for treatment and applied Behavior Analysis unless they have an authorized diagnosis through this multi-disciplinary system
• 59:30 - 60:00 so anybody can refer a child to get a diagnosis but the diagnosis itself is um that controlled mechanism that I was talking about through Blue Cross Blue Shield where you have to be what they call an AAE which is an Autism approved Autism Center for evaluation so um that's really important that they do that because if they don't um we can't start evaluation processes to get them started with applied Behavior Analysis
• 60:00 - 60:30 which we will talk about next so hopefully that was the question that you were looking for if not um go ahead and send it in again and maybe I can fix it so anyways applied behavior analysis is um the gold standard treatment for autism um basically what applied behavior analysis is is it is a it is an intervention that really assesses behaviors of the child on an individual basis and it assesses how those behaviors are manifested in the
• 60:30 - 61:00 environment so we're working with each individual child and their actual Behavior we're observing it we're measuring it and then we're using our objective data from our observations to make databased decisions on what that child needs to learn how we need to change their behavior how we motivate them to make changes so we're going to talk a little bit about what that looks like it's all based on learning theory and basically we have these this interactive Circle between Behavior
• 61:00 - 61:30 environment and what's going on in our head so the idea is is we make modifications to the environment which then motivates us as individuals to change our Behavior so I can't change your behavior specifically I can't make you do anything that you don't want to do but what I can do is I can change the environment which then could motivate you to to then make a change in your behavior so if I turn the air
• 61:30 - 62:00 conditioning on really really low right now if somebody's got a sweater over the back of their chair that might motivate them to put their sweater on it might motivate them to do a couple other things like maybe get a cup of coffee or things like that so I didn't make you do those things but by changing something in the environment I can then motivate you to make a behavior change if that particular behavior is reinforced you're more likely to do that Behavior again in the future if that behavior is not reinforced or if it's punished in some
• 62:00 - 62:30 way you're going to be less likely to do that again in the future so that's kind of the underlying premise of learning theory and what all of our treatments are based on when we're looking at applied Behavior Analysis so we learn through two different ways and most people are pretty familiar with the modeling way um people kids adults they watch other people they do what other people do and then those behaviors are often rewarded but there's also contingency learning and this is something that we focus on a
• 62:30 - 63:00 little bit more specifically with applied Behavior Analysis because kids with autism are not modeling one of the problems with kids with autism is they're not attending to their natural environment and they're not imitating what other people are doing so they're not getting exposed to the contingencies that everybody else is being exposed to so we look at trial BYT trial learning which basically means that that environmental contingency that I described through learning theory we try to evaluate that and then we try to modify it so I may make a change to the environment with a
• 63:00 - 63:30 very specific motivation to try to encourage you to do a different Behavior I may reinforce a very specific behavior that I want to see again so I'm manipulating that on a trial by trial basis to try to move that child in One Direction or another I'm either trying to increase their behavior because they have a lack of behaviors within all those skill deficit areas so I'm trying to teach them new behaviors or like in some of those Behavior problem areas that I was talking about I'm trying to reduce Behavior so I'm trying to change the contingency so that they are not
• 63:30 - 64:00 motivated to engage in those particular behaviors so this is a diagram that really just kind of is um highlights those two things so we're looking to either reinforce Behavior or we're looking to punish it or extinguish it which would be the other term so reinforcement most people are familiar with I'm going to give you something that's going to encourage you to do something again or negative reinforcement is actually um I'm going to take something away which is going to encourage you to do it again so for
• 64:00 - 64:30 example a negative reinforcement contingency would be if I'm in the car with my daughter who's 13 and she turns on a Justin beaver song I may be um not very happy with that so I may engage in a behavior that then gets her to turn that channel so that I don't have to listen to Justin Bieber and if I do that in her presence and she changes that environment the way that I want her to by taking away that Justin Bieber song that's going to reinforce my behavior so I may go hey turn that off and then if she turns it off the next time I hear Justin Bieber on the radio with my
• 64:30 - 65:00 13-year-old I may go hey turn that off and that reinforce my behavior by taking away something I didn't like so I can add something to the environment that I like which will increase my behavior or I can take something away from the environment that I don't like which will also increase my behavior most people are familiar with punishment something bad happens when you engage in some certain Behavior you're less likely to do that again so those are the two premises that we're working on with applied Behavior Analysis there are lots of different strategies also within applied Behavior Analysis so sometimes parents and professionals are confused
• 65:00 - 65:30 but some common things that um that we use in applied Behavior Analysis might be um discret trial teaching incidental teaching natural environment verbal behavior these are some slang words um PEX that's something that people may have been familiar with PEX is a um a picture exchange Communication System it's used for kids that are non-verbal um other things that you might see in a classroom time out for example or sticker charts or those kinds of things those are also based on applied Behavior Analysis so anything that we're going to
• 65:30 - 66:00 do excuse me anything that we're going to do that's going to systematically manipulate something in the environment that's going to have a motivational change towards behavior is going to be based on applied Behavior Analysis and it's going to be very very different for each individual who's targeted for treatment because we do a lot of assessment and we take ongoing data for Progress monitoring and then we're really looking at that to develop how are we going to make this change so we use applied Behavior Analysis to positively impact a lot of different
• 66:00 - 66:30 things we're trying to change our non-verbal Behavior we're trying to increase just in general cognitive functioning like IQ we're trying to increase language both receptively and expressively we're trying to increase just general knowledge skills communication daily living skills we're trying to increase social skills we're trying to increase motor skills pretty much anything that you can do we can increase so if you have a deficit in a certain area we're looking to try to increase those things so that you're performing at more of a a typical development level so we're looking at
• 66:30 - 67:00 comparing you to your peers and then trying to say where can we fill in the holes and we just start building skills we're also trying to as I said reduce some problem behaviors so some things that we might be targeting are the obvious ones like tantrums and crying and those kinds of things that are often associated with kids with autism as well as other kids who don't have very good communication skills we're ALS looking to reduce things like self-injurious Behavior or self-stimulatory behavior non-compliance
• 67:00 - 67:30 kids at aope run away um we can also reduce some other things that people don't always think about so we can reduce anxiety we can reduce like oral mouthing we can reduce arguing we can reduce hyperactivity we can reduce anything that you can do so again anything that's a behavior by changing the environment and by teaching some skills or you know focusing on um decreasing certain things we can start to modify some of these so these are just some of the things that we might work on in applied Behavior Analysis pretty much anybody can benefit from
• 67:30 - 68:00 applied Behavior Analysis because again it's just skill building and behavior reduction so we use apply Behavior Analysis for kids with autism because it's a funded Source we have permission to get paid to do work with kids with autism using applied Behavior Analysis but um pretty much any kid of any age is going to benefit if you systematically look at the environment and make some modifications to promote learning so all of the kids that come to our Center whether they're two or whether they're 20 we can definitely make changes with
• 68:00 - 68:30 them if they have really moderate deficits versus really significant deficits we can also make changes with them so some of our kids are going to be really high functioning some of them are going to be really low functioning some are going to have really aggressive behaviors some are not going to have any problem Behavior so really again this is a very individualized type of intervention the key thing that we're looking for is parent motivation we want the parents to work with us as a team member we want them to be really participating with treatment we want them to be engaged because in order for
• 68:30 - 69:00 this to work it's not only us that has to promote changes within the environment but they have to have changes in the environment across all environments so in the home in the school and other places that the children go so the parents really are often targeted as um needing to develop skills as well all parents come with different skill levels which I'm sure everybody in this room knows but when you have a child with a disability sometimes you have to learn a different skill set and we really focus on what is the what is your child need within the
• 69:00 - 69:30 skill deficits that they have that you need to do differently and then how can we promote that within you so that you're having more success in your own environment treatment is really different um depending on what your goals are there are um a lot of research articles that support the idea that about 50% of kids who enter treatment and get a very intensive behavioral Intervention Program at an early age could come out of that within 3 to 5 years as not needing additional services
• 69:30 - 70:00 so not that we're curing autism but we're teaching enough skills so that they become just like their typical peers in the areas of social skills communication and behavior so if we can catch them early we're looking at reducing special education services we're looking at reducing Community Mental Health Services we're looking at reducing medical bills and all of those other kinds of things there's also some new data that shows that if we get kids when they're two they don't need that much therapy they need one to two years of therapy if we get kids that are three
• 70:00 - 70:30 to five they need a lot more therapy so catching them earlier means that they have a lot less skill deficits and that means we have a lot of less lot less work to do so it's really really important that if we can catch these kids early not only does it change their developmental trajectory it changes how they're going to live how productive they're going to be how they're going to work in their schools how they're going to work as adults so again that cost reduction piece that we were talking
• 70:30 - 71:00 about at the beginning so when you're thinking about applyed Behavior Analysis what makes applied Behavior Analysis different than other approaches is it's functional and what I mean by functional it's is it's not just related to skill deficit it's related to motivation so I'm going to teach you something but I'm also going to motivate you to do it so we're really looking at what we call function-based treatment or functional communication training those types of things so we want to teach people to do things that are going to get their needs met in their own environment so if I
• 71:00 - 71:30 have a child who's not speaking I'm not going to teach them their alphabet I'm going to teach them something that's going to be really functional that they're going to directly use in their environment today right now so it's really important to think about that the other thing that makes ABA really different from other things is the high amount of structure so we're really programming for everything and we're really giving lots and lots of learning opportunities which is different than a classroom again we're looking very specifically at that child and we're
• 71:30 - 72:00 making sure that every single time that we ask a child to do something we're looking at that consequence was it reinforcing for them to do that were they motivated to do that are they going to do it again in the future so those are some of the things that makes it a little bit different um focusing on high family involvement focusing on strategies for generalization focusing on transitions making sure that we're collaborating with all these different environments and and again that small ratio I didn't mention this yet but ABA is typically done in a one-on-one
• 72:00 - 72:30 setting so the services that we're looking at one of the reasons why they are so costly is because we have one behavioral technician that works with one child for 20 30 sometimes 40 hours a week and that's a lot of time but when you think about the gains that you can get in that short period of time we're really trying to increase the number of learning opportunities that that child has so that they can overcome some of their skill deficits if you're looking for a tool that gives you some information oh I'm
• 72:30 - 73:00 sorry go ahead that's okay um the question would be for me is is there any evidence to show that children that did not have the Early Intervention when they were younger that have a diagnosis of autism don't get started or have any type of therapy later in life like 16 17 18 is there any studies or research that's done with those folks using this therapy and any positive results like there was no Diagnostics done they were young they knew something was wrong but they didn't have this intervention at
• 73:00 - 73:30 that young age right so the question is whether or not there's any research or literature that shows positive impact for children receiving applied Behavior Analysis at an older age so not at that preschool age and actually um there is literature going back 50 or 60 years that talks about different behavioral strategies used to increase people across all kinds of diagnoses if you look in applied Behavior Analysis literature most of these things are single subject design so what's missing
• 73:30 - 74:00 is there's not a large group design to show exactly what the overall benefits would be but there are hundreds and thousands of single subject or small group designs with kids of all kinds of Ages now what happens with older kids is they have a lot further to go so you're not going to get to the point where they're not going to need Services they're going to need services but how much they're going to need and what problems they enter with those things are going to um be determined by how much intervention they get they're going to be determined by um
• 74:00 - 74:30 what kind of behavior problems they had so a child who comes in with high rates of self-injurious behavior and aggression not going to make the same kind of progress we would our goal would be let's reduce those behaviors let's get them you know functioning out in the community let's get them learning how to shower themselves let's get them learning how to you know make their own lunch those kinds of things we might be working on still very significant things that improving the quality of life of a um a young adult with somebody with autism or an adolescent of somebody with
• 74:30 - 75:00 autism so these things are going to be effective there there are I would say I'm not familiar with anything that just does a um an intensive behavioral intervention with um a group of kids that are significantly older I think there are one or two studies that compare um the outcomes of younger children to older kids but they're not they're they're like six or seven years old they're not they're not not much older if that makes sense but what we know with applied behavior analysis is it works across a
• 75:00 - 75:30 lot of different um diagnosis behavior problems you know pretty much you're just changing behavior and a behavior is a behavior is a behavior okay so um ASAT online which um you can Google is a um a resource that if you want to look up different treatments for kids with autism they actually have a whole laundry list like hundreds of different things and then you can um click on those things and then it will tell you
• 75:30 - 76:00 what the research is behind it so it's a really cool resource because if you're looking for evidence-based treatment and you're looking to see is this going to work is this going to be harmful you know is this going to be really good um it's a nice resource for um parents and professionals um so now we're going to talk a little bit about what you might find in an Autism Center so there are different um types of centers you might have a a center based program you might have a homebased program but excuse me when a child enters applied Behavior Analysis treatment we
• 76:00 - 76:30 have to do an additional assessment so we have a diagnostic assessment and that tells us yes the child has autism but now we need to do a functional behavioral assessment we have to not only figure out that they have autism but what exactly are all these skill deficits and what's motivating them to engage in this Behavior instead of that so there's another step in the process unfortunately for parents but it's a necessary step so that we can put a plan together that's going to be be effective um different programs are going to take different kids um taking older kids is a
• 76:30 - 77:00 newer phenomenon in our state it's not something that people have been doing for a very long time so not everybody has experience many people have just been trained in preschool interventions so you may find programs that won't take children that are older but you definitely want to ask and you want to look into those kinds of things um different programs are going to be able to handle different levels of behavior as well um some programs they're not going to have staff that are going to be completely prepared to deal with really aggressive or severe types of behavior
• 77:00 - 77:30 so um you might want to also look into what is the training the qualifications those kinds of things at each individual Center but um for example at the center that I work at we have different age groups we have young kids like um preschool age kids we have um Elementary School age kids we have Middle School age kids we have high school kids and we have different things that we do with them um different kinds of programs for our middle school program we have like an after school kind of thing so the kids come for Less hours but um we also
• 77:30 - 78:00 again look at each individual so sometimes our kids will actually come to our Center um instead of going to school depending on their level of severity if they have very severe behavior problems and they're not functioning very well in that setting they may come to our Center for a period of time instead of going to school so we may have a seven-year-old or an 8-year-old who has um 30 or 40 hours of intervention a week and then once we kind of get some Behavior under control once we get them attending to the right stimuli in their environment we push them back into the school and
• 78:00 - 78:30 then they do much better one of the other things you want to look for at Autism Center is um what kind of parent services do they have do they meet with the parents regularly do they have any parent groups do they have parent education those are things that are really important um you want to again look at the age um look and see do they have any kind of transitioning programs if you're looking at somebody who's like 18ish you know where are they going to go next are you going to do this procedure with them and then they're just going to go back into the world the way that they were cuz that may not maintain so those would be good
• 78:30 - 79:00 questions to ask um the people who provide services at an applied Behavior Analysis Center um would be at the top of bcba a bcba is somebody who's a Master Level clinician and they would develop treatment plans and they would train staff and parents sorry I'm going to go back for just a second underneath of them this is really a train the trainer model so underneath of them there are several levels of professionals um the person who works directly with a child is um typically called a registered behavioral
• 79:00 - 79:30 technician or sometimes just a behavioral technician a registered behavioral technician is going to have a little bit more training and education and they have a specific certificate they are the person that's going to put in the bulk of the hours they're the person that's going to do 20 hours a week or 30 hours a week or 40 hours a week with this kid but they have less training and because this is a train the trainer model the person with the most training is at the top of the pyramid that's the bcba and then they they have to monitor all these people below so there's actually um a middle person in our state there's not a lot of them um
• 79:30 - 80:00 our state is really pushing to develop these people but that is a a person who has an undergraduate degree and they would have a certificate called a bcaba so that is a behavior analyst assistant basically so you have your behavior analyst who's running the show then you have your assistant and then you have your technician the role of the assistant is to help with additional training and to um support the B B CBA currently if you're looking at a case load for a bcba you're looking at maybe 10 maybe 15 cases because it's very
• 80:00 - 80:30 intensive you're looking at a lot of hours and there's a ratio of supervision of 10% so if you have a 20 hour a week program where you have a behavioral technician working with a kid for 20 hours a week we're going to expect that the bcba is going to be involved in that case for two hours a week because they need to meet with the parents they need to train the staff they need to supervise they need to be looking at progress data so the more hours each child has the more hours of supervision you can expect so with that kind of supervision you're looking at a small case load if you have a bcaba in the
• 80:30 - 81:00 middle they can help to extend the bcba's case load so they can do some of those supervision times they can do some of the training so then the bcba doesn't have to be so involved with the case and maybe they go out once a week instead of twice a week or something like that so that's kind of the Train the trainer model and those are the things that you can expect um one of the things that we also recommend for Applied Behavior Analysis um right now is some sort of a review of cases so many times Behavior analysts are out working in the community kind of independently um one
• 81:00 - 81:30 of the things that um has happened in our community recently is behavior analysts are very new this is a new job this is a new profession for our state because the funding source just started a couple of years ago so we have gone from less than 100 bcbas in the state to over 400 bcbas in the state in two years so it's really important that those new professionals out in the community are getting support from other people who are either more experienced or other medical professionals again this is a
• 81:30 - 82:00 very complex diagnosis so we want to make sure that cases are being reviewed this is something that um some of the centers are starting to do I think it's a really good idea um again that multi-disciplinary approach if we are going to have applied Behavior Analysis we really need to focus on what other professionals need to be involved and what kind of coordination of care do we need so if you have a child that you are working with that you refer for evaluation and then they are now in and applied behavior analysis program I
• 82:00 - 82:30 highly recommend that you try to communicate with that professional again a lot of these people are new they're kind of overwhelmed they're probably taking more cases than they should so Reach Out contact those people try to coordinate because what they're asking the families to do may be very different than what other professionals have asked them to do in the past or what you're doing may really impact what that child's going to do in treatment so the coordination of care is really um a necessary step in this especially if we want behaviors to cross over from the treatment setting to the other settings
• 82:30 - 83:00 in the community so that's very important this is the website that you guys can go to for the um autism approved evaluation center so I'm not going to go over that because we talked about it already so one of the reasons why I give you all this information is because you are the people out there working with the families you are the people out there who are um obviously interested in providing care for people with Autism and this is again a very new service
• 83:00 - 83:30 parents don't know how to navigate it they don't know what's good what's bad so by me telling you what the gist is for what you can expect for services you now have some information about how to help navigate the parents through you know is your program doing this are they offering this oh they don't have people that have worked with older kids maybe you need to look for another agency maybe that person needs to get support here are some other places so I think it's really important because it's so new nobody can really tell is it good or
• 83:30 - 84:00 bad is it working is it not working because people out in the world don't really know what to expect as of right now so hopefully you can take this information you can educate yourselves you can educate the people that you're working with and you can educate the parents who are trying to access these Services services so that they're getting good quality services as well um one of the things that we have to do quite a bit when we're working with insurance companies is um a lot of coordination of care and this kind of
• 84:00 - 84:30 goes back to making sure that we're really focused on communicating with each other um for example Blue Cross Blue Shield has mandates for us within the treatment plan that they want to know who we talk to they want to know how frequently we talk to the speech and language therapist they want to know how frequently we talk to the school they want us to document that because they want that crossover they want that generalization so it's important for everybody out in the community to really help to promote that it's also important to recognize things like goals hours um
• 84:30 - 85:00 certain standards criterias a lot of those things are also um highly reviewed by the insurance companies and they're looking at these treatment plans very strictly so it's important to kind of realize that sometimes when we ask for kids to be either removed from this or pulled out from this or something like that the insurance company actually has to approve that so it has to be medically necessary for that child or the insurance company isn't going to authorize it these are some um resources that you
• 85:00 - 85:30 can look into I'm not going to go through each of them because um one we don't have time but you guys all have access to the internet but um in particular the autism Alliance of Michigan which is number three on the list they um they have a navigator system so if you go to their website and you're looking for services that's a really good one you can find speech and language you can find ABA you can find pediatricians you you can find a lot of things and they um sort it by County so you can do it by location which is really nice um there's another
• 85:30 - 86:00 slide is it this one nope this one um this this particular no not that one this one I'm going to open this one up I want you guys to see this if you're trying to navigate um for Medicaid families you want to find services for them that's a little bit different so let me show you that really quickly so you would get if you clicked on that
• 86:00 - 86:30 link that I showed you you're going to end up here and this is super cool because when you go through here you can go okay here's my County we're in Ionia County is that right Kent County okay we're in Kent County we're going to go to Kent County and then it should do you have services in Kent County let's go to Ionia County okay maybe there's no services in Kent [Music] County okay so if we're in Ionia County
• 86:30 - 87:00 and we click on Ionia County we can go through and say all right these are the pH or PPS within that region this is the person that I call if I want to get access to applied Behavior Analysis Services if I want to get um a a diagnosis for this particular child this is how I get into the system so it's super cool it makes it really easy um that they just go into whatever the county that they have and then these people will help to navigate most of
• 87:00 - 87:30 these places don't have people that work directly for Community Mental Health most of these places are Contracting with other applied Behavior Analysis um providers and they're you know doing it that way sometimes an applied Behavior Analysis provider is covering like several regions so that may be happening as well there are some waiting lists but um this is a good tool um if parents are looking for that there's other stuff on there if you guys want to know about autism legislation if you want to know about all that kind of stuff that is also
• 87:30 - 88:00 there okay um just to go back for a minute this is just general medical information for the most part um on autism if you go to these websites some of the stuff that I talked about early on about prevalence rates and things like that if that's of Interest those might be better resources for for you in that area Okay so we're going to spend the last few minutes talking about parent
• 88:00 - 88:30 perspective this is really important because the parents are the people that are going to get the children into services so I don't know if anybody's everever had an experience where let's say they go to the doctor and they get some sort of a recommendation from their doctor their doctor says you should take this medication or you should take that medication or you should to follow up and get this evaluation and you don't do it right there's a lot of people probably everybody in the room has
• 88:30 - 89:00 probably had at least one incident where they have been told by a medical professional that they should do X Y and Z and then they've just decided maybe it's not the right time for them to do that or whatnot so um this is the same kind of thing and if we had other people supporting us and saying hey it's really important that you do that or this is a really big deal or this can't wait we might be more likely to follow through with that treatment and adhere to whatever it was that the doctor recommended so these are the kinds of things that I want you to think about
• 89:00 - 89:30 when you're thinking about the parent perspective so we're going to start off by talking just a little bit about um a study that really assess the parents um I guess the parents perception of of how they have um engaged other treatment providers so in this study um by MacIntosh and um his colleagues they looked at uh 486 parents and More than 70% of them said that they
• 89:30 - 90:00 were dealing with um increased levels of stress so that's an important to thing to think about so you have a child with a disability obviously that's going to increase stress your child's not talking to you they're not playing with you they have all these odd behaviors so you're going to feel stressed out think about the little girl that was lining up the cups if that was every day in your house you would be a little bit stressed out so we have an increased level of stress stress when you have an increased level of stress other things tend to Fall by the wayside your own personal self-care
• 90:00 - 90:30 how often you're going to go to the doctors what's going on in your life some of those kinds of things one of the other things they assessed is the relationship that parents have with the professionals that they're engaged with and they said that 73% of parents reported negative relationships with service providers including Consultants behavioral Consultants behavioral technicians psychologists and pediatricians so they're going to access Services where they're trying to reduce their stress and they're trying to get you know better services for their kids
• 90:30 - 91:00 but they're not having good relationships they're not trusting those people they're not communicating very well with those people they're not feeling like they're getting their needs met so when we're thinking about that and we're thinking about access to treatment and we're thinking about follow through and we're kind of thinking about what the parents perspective is it's really important that us as professionals are very supportive in nature but we're also really focused on making sure that the parents are actually getting their needs met because if the parents aren't getting their needs met they're not
• 91:00 - 91:30 going to be very motivated to implement the treatments that you're asking or even show up to the appointments that you're asking them to so that's a very important thing to be considering um just a little quick um excerpt I'm just going to read this the responses from our participants suggest that the process of accessing desired treatments managing the costs of money and effort and dealing with a wide array of Ever Changing professionals disrupt the equilibrium to the entire family so this is hard to navigate one it's new so
• 91:30 - 92:00 it's hard for us to implement it because we're navigating a new system but then it's hard for them because we are constantly changing things we're having a difficult time because our case loads are too high and all of those kinds of things and it really makes it difficult for the parents another thing that I didn't mention um when dealing with insurance it's great that this has been picked up by insurance but if you have private insurance you still have co-pays and it there's a co-pay for every day that you show up to treatment if you
• 92:00 - 92:30 show up to treatment every day so five days a week which is typical for our kids and you have a $20 co-pay now you have a $100 a week fee on top of what you were already doing even though it's not going to cost you 50,000 a year which is what it would cost you without insurance it's still going to cost you an extra $500 a month which maybe you don't have or maybe you have to give something else up because now you have to pay for that so so that's something to think about as well um the diagnos diagnostic process is very difficult as I said um you have
• 92:30 - 93:00 to sometimes wait up to 16 months by the time you get that referral or that M chat where you're like you need to go and get a diagnosis then you've got to go and there's a waiting list there's also typically three appointments just for the psychological diagnosis you do the parent interview you do the then you have a feedback then you have to see the neurologist which who know who knows how difficult it is to get in into them and then you have the speech and language evaluation and then you have to wait until the three of them get together so there's all kinds of
• 93:00 - 93:30 roadblocks the reason I say this is because it might help just to let the parents know this is this is what you might expect because if you know something it's easier to deal with it reduces your stress it might also be helpful for you to be a supportive person and kind of follow up on that process where are you oh you your kid was sick did you reschedule that appointment those kinds of things can be very helpful the diagnostic process itself is just unclear and it's one of the things that parents report as very problematic and it often results in
• 93:30 - 94:00 people not showing up to their appointments we have a tremendous cancellation rate for the as big of a waiting list as we have we still have probably one person a week that cancels and then we have an open spot and a lot of that is because we didn't coordinate care as well as we could have so overcoming some of these barriers to treatment really has a lot to do with parent motivation so we want to reduce parent stress when possible we
• 94:00 - 94:30 also want to educate parents and some of the things that I talk to you about applied Behavior Analysis because we're asking them to devote a huge portion of their life to this treatment we're asking them to give up something for several years potentially and take their kid to some treatment facility for a long period of time every single day they have to really believe that's going to make a difference for them because it's really hard to do something for a long time like that if you don't see the benefit for that so it's important that we all work together to make sure that parents really understand what the outcomes are and the more you guys know
• 94:30 - 95:00 the more you can help them understand and the more likely they are to stay in treatment so other things like inconsistent discipline lack of structure families feeling isolated and parents just not feeling very efficacious about their ability to parent their own child those are things that also decrease motivation those are the things that we focus on in apply Behavior Analysis so if they get into treatment that's going to be very helpful and you might start to direct people into those things like hey make sure that you ask your
• 95:00 - 95:30 therapist about that or have you thought about increasing what you're doing at home based on applied Behavior Analysis so that we can help with structure or parenting or discipline parent involvement is probably one of the most important pieces because we can work with kids all day long but not having them engaged in therapy is really problematic because it it really increases the cost because we have to do a lot more work to coordinate with everybody else it decreases
• 95:30 - 96:00 generalization of skills we may teach something to a child that never shows up in the community because we haven't gotten that involvement and also if parents learn this stuff they become lifelong advocates for their own child and they become educated in a way so that they can promote continued learning even after they're out of treatment so why do we talk about this how can can you help one of the things that we really need to think about is excuse me from the aspect of
• 96:00 - 96:30 treatment for the parents what can we do for them to support them and get this over get them over this hump and really I'm going to go through some specific things we have educational goals for our parents we have things that we want them to learn as well and I mentioned that in the beginning but we really want them to First first and foremost understand their child's disability it as I said it looks very different across different children so they may not have a good
• 96:30 - 97:00 picture of how does ASD impact my child so we want them to have a really good understanding of that we want them to understand the trajectory of the diagnosis we want them to understand how it could affect them in their school in their community in all of those places we also want them to really understand the treatment that they've been engaged with again because it helps to promote the better um better generalization better skill acquisition so we we really want them to understand that piece as
• 97:00 - 97:30 well one of the key pieces to making this all work is our communication and because the parents are one of the treatment team members sometimes they're coming with different skill sets like I said too and sometimes they don't have very strong communication skills or they're not very persistent or they have other things that are stressing them out that are making them not have the skills to be able to effectively communicate so a lot of what we do is also educate our parents on how do you do these things what do you need to take to this
• 97:30 - 98:00 professional how do you ask this professional this when you go into your IEP meeting what is that going to look like are you going to argue with them are you going to you know bring in some cookies and have a nice conversation you know what does some of that stuff look like to promote more effective collaboration and communication what if Mom is doing something that Dad isn't doing how is that going to impact the child in their treatment that's going to be a problem as well so some sometimes we're working with making sure that the parents are effectively communicating amongst themselves and then one of the
• 98:00 - 98:30 other big barriers is parents feeling isolated parents not knowing how to connect with their Community it's hard to go to the grocery store you can't go to the movies everybody's looking at you people come up to you and they're like I can't believe you let your child behave that way well they don't know what to say they don't know how to deal with those kinds of things so getting them connected to things in the community that are going to help them better parent their children is another way to be supportive and Empower them so whether it's what's the um noise
• 98:30 - 99:00 sensitive movie that's going to be playing in the community this week what's the parent support group is there a gymnastics place that has a developmentally dis developmental disabilities gymnastics class what's going on in your community that you can connect them to this is going to help them um understand what they need to do and it's also going to help them really manage what's going on if they still are having high levels of stress sometimes
• 99:00 - 99:30 we're working with them to just understand how to better cope we might teach them coping skills we might teach them stress and relaxation skills we might do some of those kinds of things and this all helps to make sure that our treatment is going to be sustainable over time because we don't want to invest this much time and effort and money into something like this if it's not going to actually have the effects that we're looking looking for so just in general our goal is to reduce parent stress increase communication and really
• 99:30 - 100:00 Empower them because if they're more empowered we're going to be able to help have them help us with coordination of care they're going to be the managers of their own children instead of relying on everybody else and then to really understand um the treatments that they're getting into so what I hope that you guys got from today and I'll take questions if you guys have any um after we're done here but I'm hoping that you have a better understanding of what autism spectrum disorder is I'm hoping that you
• 100:00 - 100:30 have in your head a way that you can Implement screening into your clinical practice how would you identify a child and how would you get them to where they need to go um hopefully you have a better idea now of what that evaluation process looks like so that you can help guide and support parents to get through that difficult process and then at this point you should know a little bit more about what they should expect from applied Behavior Analysis treatment and what that might look like so that you
• 100:30 - 101:00 can encourage parents to enroll in that treatment and then stay in that treatment so that they can receive the benefits and the effects of that and then also what to expect from different autism centers and some of the challenges that parents face as they're going through the motions of learning how to be a parent of a child with autism because no matter how old that child is they may be at levels of understanding the diagnosis just because of where we've been in the state with getting new Services even if they have a
• 101:00 - 101:30 child who's 15 they still may be at a different place you still may need to go through what does this diagnosis look like so those things I think are really important and I hope that you guys all got um some information that's useful to you that you can use in your clinical practice so thank you very much [Applause] so does anybody in the audience have any questions here okay I do have a question um this
• 101:30 - 102:00 is from Wayne State University and they ask can you discuss Medica medical necess necessity criteria and how that impacts how intense the ABA intervention is and that is a really good question because that is a very elusive term um we're all required to demonstrate that a child has medical necessity but the definition for that term is um kind of up to
• 102:00 - 102:30 interpretation one of the things that we kind of go by is any child who is not functioning very well in their community in their educational facility in their family home those kids would have medical necessity for treatment kids who are more significantly impaired and are having a really hard time learning from their natural environment are going to need more hours so how delayed they are
• 102:30 - 103:00 could dictate how many um service hours they need also how many behavior problems that they have could also dictate that so again for each child it's very different but sometimes we have to use our progress data to also show medical necessity and we work pretty closely with the insurance companies so that way we can talk about you know what does that look like in this child um I I don't have a really like hardcore answer for what exactly that means
• 103:00 - 103:30 because there really isn't anything out there that says this is medical necessity but if you have a child with autism and they have skill deficits and they're not doing well in their environment then they have medical necessity to receive treatment because we know how to fix those behaviors so we should do that any other questions that anybody body has okay well thank you very much for your attention and I appreciate you all
• 103:30 - 104:00 coming out