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