Expert: James Michael Roan - 9/29/2007

Question
QUESTION: My 10 month old son has been qualified for services through our school district. He has delayed motor skills, hand flapping, attractions to fans, lights, poor fine motor skills and moderate to low eye contact. He likes being held but not cuddled and he has started banging his head, he puts everything in his mouth and he doesn't like being held close. He doesn't like to look in the mirror. He babbles, but still doesn't understand "no", nor does he associate the babbling.

During the assessment the therapist said he establishes joint attention and answers to his name and those are good signs, but I am still very concerned with autism.  

The reason he qualified was they wanted to see more babbling and they felt he was a little quiet, so he will get speech therapy. Because he is  only 10 months his sessions will consist on help him establish the skills to bring him up to speed with his peers.

I know how important early intervention is, and so my question to you is how much time per week is needed for it to be effective. I know a 10 month old probably will not sit still as long as a 18 month old for therapy session, but I want him to have the best possible outcome.  Everything I read says the brain is so malleable during this time, I want to take advantage of this opportunity.

How much per week should I time should I try and fight for?





ANSWER: Hi Dawn;

To answer your question directly, you should ask for at least 20 minutes per day, five times per week.

Most important at this age and every age is that therapy occur in naturalistic settings, so learn the goal and the means and capitalize on teaching and encouraging those skills when you and others are around her at home, in the community and around other children.

The only research-based indicator of any risk for autism at this age is "not orienting to name."

Other red flags include:

6-12 Month Markers:

·   Infrequent eye contact
·   Failure to orient to name
·   Does not smile in response to smiles from others
·   Social and emotional passivity
·   Fixation on objects

By 12 Months:

·   Poor or no eye contact
·   Failure to orient to name
·   Poor imitation
·   No babbling by 12 months
·   No gesturing by 12 months

By 16 Months:

·   No single words by 16 months
·   No pointing to objects or events of interest in an effort to share

By 24 Months:

·   No spontaneous two-word phrases
·   Loss of any language or social skills at any age

I hope this helps. If you like, I can research early intervention goals for this age group.

Kind regards,
James

Kind regards,
James

---------- FOLLOW-UP ----------

QUESTION: Yes I would really appreciate that. Any research on early intervention goals for this age group would really help me. This information would be useful in setting goals at our IEP meeting. Thank You

Answer
Hi Dawn:

The following information regarding intervention comes from the autism team at the University of Washington's Autism Center led by Dr. Geraldine Dawson:

There are four Core Principles of intervention with infants and toddlers:

Principle #1: Social Engagement

Intervention focuses on shared activities including social sensory  and joint attention routines. Shared activities is where language and communication develop.

Principle #2: Development

Skills are carefully adjusted to match or slightly exceed the child's developmental level. Strategies are modeled after normal patterns of interaction and development.

Principle #3: Naturalistic Applied Behavior Analysis (ABA)

Naturalistic ABA approaches are emphasized such as Pivotal Response Training. Other naturalistic approaches include Stanley Greenspan's DIR Floortime Model for establishing joint attention. These approaches are designed to promote communication development, motivation, and positive affect.

Principle #4: Partnership with Parents

Parents are partners and the experts about their child. Parents are key to their child's development and generalization of new skills to multiple settings.


Other elements of a comprehensive learning model include a comprehensive developmental curriculum; interdisciplinary to include speech and language, occupational therapy and pediatrics. Intervention should consist of 20-25 hours per week and slowly transition from one-to-one to small group activities.

The biggest issue is that intervention and therapy start "yesterday."

Kind regards,
James