early childhood mental health and improving early ... fall institute 2017_rrn_rsh_no notes.pdf ·...
TRANSCRIPT
Early Childhood Mental Health and Improving Early Identification of Developmental Delay and Autism
Spectrum Disorder
Friday, September 22, 2017
1:15 PM-2:45 PM
Rhonda Rairden-Nelson
Rachell Swanson-Holm
• Understand the importance of early childhood mental health.
• Define Autism Spectrum Disorders, symptoms, social, behavioral, and communication differences, causes and diagnosis.
• Name possible diagnoses other than Autism Spectrum Disorder
• Increase awareness and knowledge of the CDC’s Learn the Signs. Act Early. program, materials and online trainings available.
• Describe ways to integrate Learn the Signs. Act Early. materials into early education and child care sites
• Increase existing developmental screening by engaging families and staff in monitoring milestones as part of the assessment process
• Understand how the LTSAE materials can support referral of infants, toddlers and young children for eligibility evaluation by Part C and Part B Services
Objectives
• Mute your phones please
• There will be time for questions and answers following the presentation
• If you would like more resources by email and other information, please leave your request and email address on clipboard provided
Welcome and Thank You For Attending!
Housekeeping Items
Who We Are
Early Childhood Mental Health
What do we
mean by
INFANT AND
EARLY
CHILDHOOD
MENTAL
HEALTH?
Otherwise known as
SOCIAL or EMOTIONAL
DEVELOPMENT
early childhood mental health
refers to a young child’s ability
to….
Form Close Relationships
Explore New Environments
Express and Manage their Emotions
Social and emotional wellbeing
includes the development of:
• SELF-WORTH
• SELF-CONFIDENCE
• SELF-REGULATION
Healthy social, emotional
development is
FOUNDATIONAL
to success in
school and in
life.
Approximately
17% of all
children
experience a
mental health
concern before
the age of 6.
(Source: Klitzing K von, Doehnert M, Kroll M, Grube M:
Mental disorders in early childhood. Dtsch Arztebl Int 2015;
112: 375–86. DOI: 10.3238/arztebl.2015.0375)
• Relationship Disorders (Attachment)
• Mood Disorders such as Anxiety and Depression
• Feeding Disorders
• Motor Dysregulation (ADHD)
• Post Traumatic Stress Disorder
• ASD
Mental Health Concerns
ASD is classified as a neurodevelopmental disorder with onset during early development, often before a child enters grade school.
• Characterized by:
1. Persistent deficits in social communication,
2. Social interaction, and
3. Presence of restricted, repetitive patterns of behavior, interests, or activities.
Autism Spectrum Disorder
Deficit in Social-Emotional Reciprocity exists across various social situations: Ability to engage with others and share thoughts and feelings:
Struggle to know when and how to join a conversation and identify what to say,
Difficulty maintaining a conversation; back and forth exchanges are challenging or absent,
Difficulty or lack of sharing thoughts and feelings with others,
Impaired joint attention as displayed by a lack of pointing, showing, or bringing objects to share interest with others,
Lack of shared social play and imagination, and insistence of playing with very fixed, defined rules,
Preference to play on their own or with much younger or older people, and
Imitation of others’ behavior is absent or reduced.
Communication & Social interaction Deficits
• Repetitive motor movements, use of objects, or speech
• Inflexible adherence to routines, insistence of sameness, or ritualized patterns of verbal or non-verbal behavior
• Highly restricted, fixated interests
• Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of their environment
Restrictive, Repetitive Behaviors & Interests
• Deficits in nonverbal communication behaviors, such as atypical use of eye contact, gestures, facial expressions, body orientation, or speech intonation.
• Delay in language development and comprehension, ranging from complete lack of speech to delays, echoed speech, and overly literal speech.
• Intellectual impairment, motor deficits (e.g., clumsiness, odd gait, walking on tiptoes), self-injury behavior (e.g., head banging, biting the wrist), and anxiety and depression.
Other Associated Features
• There is no one medical test that can diagnosis autism.
• Diagnosis should only be made by specially trained physicians and psychologists who will administer autism-specific behavioral evaluations.
• A typical diagnostic evaluation will involve a multi-disciplinary team of doctors, that may include a developmental pediatrician, psychologist, speech and language pathologist, and occupational therapist.
• A diagnosis can open access to therapies and assistive technologies that can improve function in areas of difficulty.
• Diagnosis can provide relief to families who have struggled to find answers. However, it can also be very anxiety provoking as they come to terms with the diagnosis especially if the next steps aren’t identified.
• https://www.autismspeaks.org/family-services/tool-kits/100-day-kit
Diagnosis of ASD
Each individual with autism is unique so each autism intervention plan should be tailored to address specific needs.
• Medications
• Speech therapy
• Occupational therapy
• Psychiatrist/Psychologist sessions
• Behavioral and social skills therapy programs
• Applied Behavioral Analysis (ABA)
Treatment
• Intellectual Disability (ID ) Global Developmental Delay
• Speech and Language Disorders
• Attention Deficit Hyperactivity Disorder
• Disruptive Behavior Disorder/Oppositional Defiant Disorder
• Anxiety Disorders
• Nonverbal Learning Disorder
• Social Communication Disorder
Is It ASD or Something Else?
• Total Population=3,134,693
• Percent of population under 5 years of age =6.4%
• Median Household income=$53,183
• Poverty Rate=12.2%
• State Ranking of Child Well-Being=5 out of 50
• Largely agricultural state with large rural geographical areas
• Significant underserved populations with a limited amount of providers
Iowa
• Developmental disabilities are common
• About 1 in 6 children ages 3-17 has a developmental disability1
• In the United States, about 1 in 68 children has an autism spectrum disorder2
• Median age of ASD diagnosis is 4 years
• 12-16% U.S. children have a developmental or behavioral disorder
• Prompt identification can spur specific and appropriate therapeutic early interventions
• Fewer that 50% of pediatricians use valid and reliable screening tools.
• 30% of Primary Care Providers follow the AAP Screening Guidelines
Issues
Developmental Monitoring
and Screening: Activities
• Milestones are things most children can do by a certain age
– How a child plays, learns, speaks, acts, and moves
• You see these every day
• They offer important clues about each child’s developmental health
• Parents may need guidance in recognizing them
Developmental Milestones
All children develop at their own pace. Some will reach milestones slightly late or early.
• Parental concerns about child development are highly predictive of true developmental problems (Poon, LaRosa & Pai, 2010).
• Parents of low Social Economic Status (SES) are less likely to bring up concerns, but when asked they were accurate with concerns similar to parents with moderately-high SES. (Glascoe, 2012).
• Preliminary data suggests that when developmental monitoring and screening occur simultaneously, identification and access to services increases (National Survey of Children’s Health; 2007; 2011-2012).
Caregivers are Important Partners
• Recent research tells us as many as 1 in 4 children
in the United States, ages 0-5, are at moderate
or high risk for developmental, behavioral or social delays
• 1 in 6 children has an identified developmental disability and/or delay
• 1 in 68 children are identified with autism
Why Track Milestones?
Reference: (Blumberg, Boulet, Boyle, Cohen, Kogan, Schieve, & Yeargin-Allsopp,
2011)
• Early identification (before school age) can have a significant impact on a child’s ability to learn new skills as well as reduce the need for costly interventions over time
• Less than half of these children are identified before entering school, and miss opportunities to benefit from early intervention
• Early intervention can have a significant impact
Why Track Milestones?
• Understand each child’s developmental progress
• Determine if a child needs extra help or has additional challenges in a particular area
• Gather objective information for talking with parents
• To build relationships with families
Tracking Milestones Helps You…
• Understand that watching for milestones is important
• Better understand child development
• Pinpoint any potential developmental concerns
Tracking Milestones Helps Parents…
• A brief, standardized assessment procedure designed to identify children at risk who should receive more intensive diagnosis or evaluation.
• Typically administered by:
– Early childhood educators
– Mental health providers
– Health care providers
• Screening tools do not provide conclusive evidence of developmental delays and do not result in diagnoses. A positive screening result should be followed by a thorough assessment.
Developmental Screening
• Developmental monitoring is done at ALL well-child visits
• In the absence of established risk factors or parental or provider concerns, developmental and behavioral screening should be done using a standardized screen tool when the child is:
9, 18, and 24/30** months
18 and 24/30 month visit ASD specific screening
AAP and CDC Guidelines
9-Month-Old Child
18-Month-Old Child
24-Month-Old Child
Learn the Signs. Act Early.
www.cdc.gov/ActEarly 34
Developmental
Surveillance/Monitoring
Done by parents, teachers, health professionals Ongoing process-begins at birth Sample tool: “Learn the Signs. Act Early.” Milestone Checklists
Formal process
Recommended by the American Academy of
Pediatrics at 9, 18, and 24 or 30 months
Done by health professionals
and may be done by teachers with special training
Uses a validated screening tool
Sample tool:
Ages and Stages Questionnaire
Developmental
Screening
Look for
developmental
milestones
Important for
tracking signs
of development
and identifying
concerns
• General Developmental Screening Tools (approved by AAP)
– Ages and Stages Questionnaire (ASQ-3)
– Parents’ Evaluation of Developmental Status (PEDS)
– Parents’ Evaluation of Developmental Status- Developmental Milestones (PEDS-DM)
– Brigance Screens
– Developmental Assessment of Young Children
• Language Screening Tools
– Communication and Symbolic Behavior Scales - Developmental Profile
• Social-Emotional Screening Tools
– Ages and Stages Questionnaire: Social-Emotional (ASQ-SE-2)
For in-depth profiles of many of the tools, see the Birth to 5: Watch
Me Thrive! Compendium of Screening Measures.
Commonly Used Developmental Screening Tools
• Validated Autism Screening Tools
-Modified Checklist for Autism in Toddlers (M-CHAT-R/F)
-Childhood Autism Spectrum Test (CAST)
-Social Communication Questionnaire (SCQ)
• Secondary Autism Screening Tools
-Screening Tool for Autism in Toddlers and Young Children (STAT)
Commonly Used ASD Specific Screening Tools
Detection Rates
Without Tools
With Tools
Developmental Disabilities
30% identified Palfrey et al. J Peds. 111:651-655, 1987.
70-80% identified Squires et al. JDBP. 17:420-427, 1996.
Mental Health
Problems
20% identified Lavigne et al. Pediatr.
91:649-655, 1993.
80-90% identified Sturner. JDBP. 12:51-64, 1991.
• Parents can detect problems with development in approximately 70-80% of children with a delay.
• When parents reported concern of emotional or behavioral issues, physicians were 13 times more likely to identify psychiatric problems and make needed referrals.
• Parents of low Socio-Economic Status(SES) were less likely to bring up concerns, but when asked they were accurate with concerns similar to parents with moderately-high SES. (Glascoe, 2012).
Accuracy of Caregiver Report
How Can I Increase Family Engagement in Developmental Monitoring and
Screening?
To improve early identification developmental disabilities and delays, including autism, so children and their families can get the services and support they need as early as possible.
“Learn the Signs. Act Early” Mission
• Developed by CDC, in conjunction with the AAP
• Help parents become better partners in monitoring development
• Objective, research-based information may make visits more productive
• Free and available in English and Spanish
Tools to Make Your Work with Families Easier
• Milestone Checklist
• Milestone Moments Booklet
• Milestone Brochure
• Milestone Growth Chart
• Fact Sheets
• Screening Passport
• Milestones Tracker
Materials to Help You
• Complete checklists address – Four domains of development
– Developmental “red flags”
• How to use – At beginning of each school
year, print two copies. Complete one at school and encourage parents to print the other.
– Use at parent-teacher conferences
• Can be printed with Spanish translation on reverse
Milestone Checklists
• Throughout the year encourage the caregiver to, pay attention to how their child is meeting milestones and mark the checklist accordingly.
• Includes:
– Complete milestone checklists (2mo – 5yrs)
– List of developmental “red flags”
– Activities to try at home
– Space to write down questions
• Intended for parent use throughout a child’s early years
• Provide one to every family when they enroll
• Helps parents prepare for well-child visits; gives you a parent-friendly reference
• Try activities in the booklet in your home/classroom at least monthly
• Include activities in your monthly newsletter
Milestone Moments Booklet
Select milestones at a glance
for ages 6 months to 4 years
Milestone Brochure/Poster
Measure each child’s height on the growth chart. As you measure, mentally check the developmental milestones for his or her age.
Growth Chart
Ask parents to order a free
parent kit, so they can track
their child’s development at
home using Milestone
Moments and the Growth
Chart.
Parent Kit
Materials specially packaged for
parents - includes one growth chart
and one Milestone Moments booklet
(English or Spanish).
• Tips for Talking With Parents
• Tips for Talking With Your Doctor
• Developmental Screening
• Condition-specific fact sheets
Fact Sheets
• The app is available for iPhone and includes the following:
– Add a child to get personalized information on your child
– Milestone Tracker
– Milestone Photos/Videos
– Tips and Activities
– Alerts when you need to “Act Early”
– Appointment reminders
– Milestone results that can be emailed to providers (or parents)
CDC Milestone Tracker
• Milestones in Action Digital Library
• Watch Me Training!
• Autism Case Training
Other Resources from the CDC
Go Out and Play! Kit
A resource to help early educators monitor development through play
https://www.cdc.gov/ncbddd/actearly/pdf/ccp_pdfs/GOP_kit.pdf
Early Educator Tool Kit
• Milestone checklists are not validated screening tools.
• The American Academy of Pediatrics recommends that all children receive a developmental screen using a formal, scientifically tested screening tool at 9, 18, and 24 or 30 months, or whenever there is a concern.
• Using milestone checklists will not satisfy this recommendation.
• Milestone checklists cannot be used to diagnose any developmental disability.
Warning
Why monitor and screen in
Early Care and Education Settings?
Most parents who bring up the possibility of developmental delays want to be heard, not just reassured
that their child is normal.
(Slices & Egbert, 2009)
Although early intervention has been shown to help…
…...most will not be identified before they enter school.
Why “Learn the Signs. Act Early.”?
U.S. children aged 3-17 has a developmental disability
1 in 6
Parents want to talk to their child's doctor and early education and care provider regularly about development.
Developmental Concerns
86%
81%
expect to talk to the doctor about their child's development during every well-child visit.
would like their child's early education provider to discuss development at least every few months.
However…. Parent knowledge is often limited to
physical and language development
Many parents are reluctant to bring
concerns to their child’s doctor
Learn the Signs. Act Early. Can fill this gap!
Parent Concerns about a child’s development are reliable predictors of delays
Past Studies have shown that LTSAE Materials…… help parents understand and appreciate Can help validate a parents concern the broad range of developmental milestones Reliably teach parents something new about Reduce barriers to parents sharing development concerns with the doctor
In intercept interviews with parents in clinics...
LTSAE changes parent behavior
91%
87%
86%
said LTSAE encouraged them to take action if they ever had a concern about development
said LTSAE made them more likely to contact their child’s doctor if they had a concern
said LTSAE made them more likely to contact early intervention services if they had a concern
Feasibility of integrating LTSAE has been demonstrated across many settings and systems • Early eduction and childcare
settings
• Childcare sites
• Pediatric clinics
• Home visiting
• Early Head Start and Head Start centers
• For education purposes (e.g. medical residency training programs)
LTSAE offers more than other lists of developmental milestones. LTSAE milestones...
• Cover the complete range of developmental domains
• Are adapted from milestones developed by the American Academy of Pediatrics (AAP), considered the “gold standard”
• Are written in plain language
• Are based on what most children can do by each age, instead of what the average child can do *
• Include information about when and how to act early
Benefits of LTSAE Materials
Next Steps
– Learning more about LTSAE resources/trainings
– Learning from others
– Building community
Technical Assistance
Contact Information
Contact E-mail Phone
Rhonda Rairden-Nelson [email protected]
515-281-4926
Rachell Swanson-Holm [email protected]
515-955-8326 866-219-9119 press 4
Questions?