It had been a long first year with Thomas. His colic lasted for what seemed an eternity, but that time seemed so long ago now that he was 18 months of age. For the most part, Thomas was doing what 18 month-olds do: he walked at 12 months of age and had some idiosyncratic language. He seemed to say "mama" and "dada," but Ian and Molly weren't exactly sure. Molly had particular expertise in the area of speech, and she wasn't concerned - at least, that's what she kept telling herself. Thomas also had tantrums that seemed to Molly and Ian to be overly intense. They weren't really sure. Thomas also seemed to be "in his own world" alot of the time, and he just didn't seem to "connect" with his parents. He didn't seem to imitate them very well, and he seemed not to like to make eye contact. Sometimes they wondered if he had a hearing problem. They tried to wean him off of breastfeeding at 9 months of age, and he didn't respond to that very well. They eventually were able to get him to take a bottle after a very carefully planned transitional period.
Molly worried that the stress of caring for Thomas during his colic had taken a toll on her. She knew that she was doing all the right things, and she also knew that Ian was a wonderful dad. Ian, for his part, was also concerned but trusted that things would work out OK - he had grown to trust a deep wisdom in himself as a result of the difficulties he had experienced in his life. Still, the two talked about whether or not to take Thomas someplace for a more extensive evaluation.
* What are the typical developmental milestones for and 18 month-old child? How unusual is Thomas' language development?
* If Molly and Ian want to take Thomas to be evaluated for Autism, where would they go? What kind of assessment is done for an 18 month-old child? Is it too early? Are assessments like this covered under most insurance plans? How much does such an assessment cost?
* What might Thomas' 18 month visit to the pediatrician look like in terms of his M-CHAT? In other words, indicate the items that Molly and Ian might endorse as "yes" on the instrument.
* Go to the website "Autism Speaks" to learn more about the condition.
DECISION POINT ::: Do Ian and Molly take Thomas for an evaluation, or do they wait to see how things go? If Thomas has autism, are there benefits to early identification?
Question One:
ReplyDeleteDevelopmental milestones are described as things that children should be expected to do at a certain age and are divided into categories such as social/emotional, cognitive, language, and physical development. In the social/emotional category, an 18 month old is expected to show affection to familiar people, play simple pretend games (such as conversations between two dolls), point to something to show interest, and may show a bit of stranger anxiety while clinging to a familiar caregiver in an unfamiliar situation. Thomas seems to be having temper tantrums, but this is a perfectly normal development at this age.
In a cognitive respect, Thomas should be able to follow very simple verbal commands such as “one more bite” without an visual cues. He is able to use coloring utensils to scribble and knows what ordinary objects are such as a spoon, crayon, telephone, etc. Around 18 months, Thomas is now able to walk and maybe even run while playing with toys and pulling them behind him. He is able to eat with proper utensils and drink out of his own sippy cup.
When it comes to communication and language, Thomas should be able to say a few simple words, point to show what he wants, and be able to shake his head when saying “no.” It seems that Thomas only knows a few words that include “mama” and “dada” which is a good sign that he is trying to communicate. He may be falling a little bit behind, however, if these are the only words that he is able to produce. If Thomas goes a couple of more months not producing simple single-word utterances, then the Mahoney’s will need to take him for a speech/language evaluation.
Question Two:
ReplyDeleteThe Mahoney’s should take Thomas to see their primary care physician for evaluation and referral to a specialist for evaluation. It is important the Mahoney’s come prepared to the visit. They should write down their concerns before the visit so they won’t forget to share important information. If the physician feels like Thomas could potentially have autism then the physician will refer them to either a child psychiatrist, clinical psychologist or a developmental pediatrician. A developmental pediatrician will generally ask the parent many questions about the child’s development and behavior. A developmental pediatrician is generally the best for evaluations because they are specially trained for evaluating delays in children.
Autism is hard to diagnose before 24 months due to the fact that symptoms often surface between 12 and 18 months. Usually between 15 to 18 months is the time parents begin to notice loss of skills or delays in development. According to Hartford (2011), “It’s very rare for a child under the age of 18 months to get a diagnosis of autism since they wouldn’t have missed many developmental milestones yet or be that delayed since they are still too young.”
In 2011, Virginia passed legislation specifically requiring insurers to provide coverage the treatment of autism. “This law requires health insurers, health care subscription plans and health maintenance organizations to provide coverage for the diagnosis and treatment of autism spectrum disorders in individuals from age two to six.” (National Conference of State Legislatures, 2012)
The M-CHAT is the recommended assessment for an 18 month-old child. The M-CHAT is validated for screening toddlers between 16 and 30 months of age, to assess the risk for autism.
Question Three:
ReplyDeleteThe M-CHAT consists of 23 questions that could be used to assess if a toddler needs to be seen by a pediatrician or neurologist for further assessment. Among the 23 questions, there are 7 that are considered critical screening questions which are numbers: 2, 5, 7, 9, 14, 15,20. Thomas is showing some minor signs that a child with autism would most likely possess. A few of the questions that would be answered yes and would spark an interest to Thomas’s parents and the prospective doctors would be Thomas’s lack of interest in other children, his eagerness to point to things to ask for something, his lack of eye contact with adults, he is easily startled and throws tantrums that seem uncontrollable at times, the lack of response when his name is called, and lastly, Thomas seems to wander around with no purpose, almost out of touch with reality.The critical questions that the Mahoneys answered out of the 7 was number 2, which states, “does you child take an interest in other children”. The previous statement consisted of at least three red flags or responses that would need further attention after the M-CHAT assessment. Because the M-CHAT is strictly a screening tool, it would only be posing the idea that Thomas maybe have autism or the results lend itself to exposing other types of developmental delays.
Decision Point:
ReplyDeleteThere are some increased risks and red flags that indicate autism in infants and toddlers. Some of these include the areas of socialization, communication, behavior, and processing. Lack of appropriate eye contact is one red flag indicator. As mentioned, Thomas is lacking this appropriate eye contact. Other red flags include lack of nonverbal communication and showing gestures, unusual intonation, and irregular speech rhythm. Odd posturing, repetitive movements and behaviors, and problems with sensory integration are also indicators. To add to that, abnormalities in cognition, strong concrete thinking, and poor awareness and judgment are also indicators for risk of autism.
Having a child diagnosed with autism can be scary for most parents. Delaying intervention or having fear or shame of early identification is never a good idea. Therefore, it would be beneficial for Molly and Ian to take Thomas for an evaluation. It is better to be safe than sorry. There are benefits of early identification and intervention in autistic disorder. This intervention could begin as soon as a child receives a diagnosis and receiving services as soon as possible could improve the child's outcome. There are so many benefits of early identification and intervention, making it evident for Molly and Ian to take Thomas for an evaluation. The "Early Identification and Intervention in Autistic Disorder" article from Love to Know website has indicated four major benefits of early identification:
"1. Early diagnosis and intervention will give your child access to important services and treatment options to significantly improve his prognosis. Services such as occupational and speech therapy are typically more effective long-term when started very early in life.
2. A diagnosis of autistic disorder grants your child the right to an individual education plan designed around his strengths and weaknesses. The sooner you discover your child's special needs, the better his chances are at a quality education.
3. Understanding the reasons behind your child's lack of communication and impaired social skills allow you to address those issues before your child completely withdraws and damages family relationships.
4. Although some parents are concerned about labeling their child as autistic, giving a name to your child's symptoms and behaviors may help you cope. Following a diagnosis and the development of a treatment plan, you may experience a sense of relief knowing your child is getting the help he needs and deserves."
Based off this information, we suggest that Thomas should be taken for further evaluation to see if he should receive services for autism. The earlier a diagnosis can be detected, the more benefits are available.
Sources:
ReplyDelete(2005). In Autism Speaks. Retrieved January 30, 2012, from http://www.autismspeaks.org/
Bortfeld, H. (2011, February 5). I Think My Child May Have Autism. Talk About Curing Autism. Retrieved January 30, 2012, from www.tacanow.org/family-resources/i-think-my-child-may-have-autism/
Center for Disease Control and Prevention. (2012) Learn the Signs. Act Early. Important Milestones: Your Child At Eighteen Months. Retrieved January 31, 2012. http://www.cdc.gov/ncbddd/actearly/milestones/milestones-18mo.html
National Conference of State Legislatures. (2012). Autism and Insurance Coverage State Laws. NCSL Home. Retrieved January 31, 2012, from http://www.ncsl.org/issues-research/health/autism-and-insurance-coverage-state-laws.aspx
Reed, V.A., (2012) An Introduction to Children with Language Disorders. 4th ed., Pearson Education, Inc. Upper Saddle River, New Jersey. Pages 40-129.
Robins, D., Fein, D., & Barton, M. (1999). Frequently asked questions. In M-CHAT . Retrieved January 30, 2012, from https://www.m-chat.org/faq.php
Signs Inc.. (2012, January 11). Recommended Screening Tools. First Signs. Retrieved January 31, 2012, from https://www.firstsigns.org/screening/to
Smith, M., Segal, J., & Hutman, T. (2010). Autism Symptoms & Early Signs: What to Look for in Babies, Toddlers & Children. Helpguide helps you help yourself to better mental and emotional health. Retrieved January 31, 2012, from http://www.helpguide.org/mental/autism_signs_symptoms.htm
University of Pennsylvania, School of Medicine. (n.d.). Common Concerns. What is Autism?. Retrieved January 31, 2012, from http://www.paautism.org/common_concerns.html#whatTodo
(n.d.). Retrieved from http://autism.lovetoknow.com/Early_Identification_and_Intervention_in_Autistic_Disorder