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Young Ones 56 by Georgina Peacock and Amanda Perez CHILDREN AND FAMILIES Back-to-School 2008 Autism Spectrum Disorders in Very Young Children Andrew is 20 months old. For the past two months, he has been enrolled in a local Early Head Start program. Carolyn, Andrew’s Head Start caregiver, is impressed at how Andrew’s mother has learned to understand his needs. Andrew’s mother talks about how independent he is, always wanting to do things himself. When he is hungry, he goes to the refrigerator and gets his milk. If he can’t reach something he wants, he uses his mom’s hand as a tool to get it. While he makes a variety of sounds and babbled “mama” and “dada” at around 11 months, Andrew does not use words to express his needs or to communicate. Jaden, now 22 months old, is also new to his home-based Early Head Start program. In initial home visits, his parents reported that he was an “early talker.” Jaden’s favorite toy is a eece dog that sings when you press its belly. Jaden sings the song over and over again and has pressed the dog’s belly so much that the eece is worn and shiny there. Jaden takes his dog everywhere and gets very upset if he can’t nd it. In describing this, Jaden’s parents tell their home visitor, Khadija, that Jaden “knows what he wants.” Khadija agrees but notices that, despite “talking” a lot, Jaden rarely makes eye contact and doesn’t seem to use language to get what he needs. When he isn’t able to communicate, he cries or screams out of frustration. He isn’t able to follow simple commands. Even when Jaden’s mother points to his sneakers and says “bring me your shoes,” Jaden does not respond. Carolyn and Khadija are both concerned about these two di erent little boys, and rightly so. Screenings for Andrew and Jaden reveal concerns about communication and social-emotional development. In keeping with the Head Start Program Performance Standards, both boys are promptly referred to their local early intervention programs for further evaluation. Eventually, with the input from family, sta , and early interventionists, doctors diagnose Andrew and Jaden with Autism Spectrum Disorders (ASDs). A GUIDE FOR YOUR EARLY HEAD START AND INFANT AND TODDLER NEEDS What you need to know and how you can help ASDs have become a “hot topic” in the media in the past few years. e Centers for Disease Control and Prevention’s Autism and Developmental Disabilities Monitoring (ADDM) Network released data in 2007 that showed that about 1 in 150 children in selected communities across the United States had an ASD. Sta in Head Start programs working with infants and toddlers likely serve young children with ASDs and may, in fact, be the professionals who identify developmental concerns and link families with crucial early intervention services. While there is no cure for ASDs, early intervention can greatly improve a child’s development. In your role, what do you need to know about ASDs? And how can you help? Autism Spectrum Disorders ASDs are a group of complex developmental disabilities that cause substantial impairments in social interaction and communication. e symptoms of ASDs are present during early childhood and last throughout a person’s life. Scientists do not yet know the cause, but it is thought that both genetics and environmental factors are likely to play a role. ASDs a ect children’s language, social-emotional, and/or cognitive development. Just as the name suggests, the symptoms and the intensity of symptoms of ASDs vary in the children who have them. Some children with ASDs are mildly a ected while others are severely a ected. e thinking and learning abilities of people with ASDs also varies — from gi ed to severely challenged. Autistic disorder is the most commonly known type of ASD, but there are others, THE MAGAZINE OF THE NATIONAL HEAD START ASSOCIATION
including “pervasive developmental disorder-not otherwise speci ed” (PDD-NOS) and Asperger syndrome. Of course, all young children are developing cognitive, language, and social-emotional skills as they grow. Even typically developing infants and toddlers must learn over time to manage transitions, engage in meaningful interactions with adults, and use their imaginations. Still, it is helpful to recognize some of the red ags associated with ASDs. Remember that in isolation many of these behaviors are typical in young children. However, a pattern of these unusual behaviors, persistent use of these behaviors over time, or impaired communication or social skills are causes for concern. As you observe children, you should both trust your instinct and use your knowledge of typical development to identify possible concerns. Now let’s take a look at some of the behaviors and symptoms common to ASDs. In comparison to their same-age peers, a young child with an ASD may… • Have trouble relating to others or not have an interest in other people at all. • Avoid eye contact and want to be alone. • Prefer not to be held or cuddled. • Have unusual trouble expressing her needs using typical words or motions. • Appear to be unaware when other people talk to him but respond to other sounds (for example, a child might not answer to his name but may look up when he hears an airplane in the sky). • Repeat actions over and over again in a persistent or obsessive way, o en without obvious purpose (for example, icking ngers or rocking back and forth). • Have extreme trouble adapting when a routine changes. • Have unusual reactions to the way things smell, taste, look, feel, or sound. • Not smile on his own by 5 months or laugh by 6 months. • Not try to attract attention through actions by 7 months. • Show no interest in games of peek-a-boo by 8 months. • Repeat or echo words or phrases said to her, in ways unlike same-age peers, or repeat words or phrases in place of normal language (echolalia). • Have other language delays (for example, no single words like “mama” or “dada” by 12 months, or no words by 18 months). • Not look at objects when another person points at them by 12 months. • Not play pretend games (for example, pretending to feed a doll) by 24 months. • Not point at objects to show interest by 24 months. • Lose skills he once had (for instance, a child may stop saying words he was once using). Sta in Head Start programs are uniquely able to support families in identifying developmental concerns, accessing early intervention, and implementing service plans related to ASDs. Head Start professionals who work with the youngest children and their families develop relationships that allow ongoing observation and discussion about child development. Sta also conduct formal screenings and ongoing assessment of children, as required by the Head Start Program Performance Standards, and recognize early warning signs of developmental delay. When sta members act early on concerns and talk with parents about what they see, children are able to bene t from the earliest intervention. Young Ones What you can do: Program directors and managers Providing comprehensive developmental services includes supporting families as developmental concerns are identi ed, diagnoses are made, and services are implemented in your inclusive setting. To support families and sta and to help set a positive tone during what is likely to be an emotionally challenging time, create an atmosphere that promotes the following: • A sound understanding of development: Head Start sta members need to have a strong foundation in typical infant-toddler development. With this knowledge and the screening and ongoing assessment required by the Head Start Program Performance Standards, sta members can help families identify potential delays and concerns at the earliest opportunities. Because children with ASDs sometimes lose skills they once had, documentation is especially important. • Observation: In their ongoing work with families, Head Start sta members have the opportunity to observe children develop over time. Talk with sta about the importance of careful observation, encourage them to talk about what they observe, and help them evaluate and contemplate their observations. • Strong relationships among sta , families, and children: Healthy relationships enable sta to observe children’s behavior, deliver appropriate curriculum, and provide information about screening and assessment to families. As an administrator, it is crucial that you recognize that identifying a delay or a disability like autism can raise many complex issues for families and sta alike. O er information on sharing screening results with families and supporting them through THE MAGAZINE OF THE NATIONAL HEAD START ASSOCIATION Back-to-School 2008 CHILDREN AND FAMILIES 57
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