Best Practices

Dr. Ozonoff talks right away about the screening process: should occur at checkups at 18, 24, 36 months; if a child fails: hearing tested, check for PICA and lead screening, screened for autism; if a child fails one of those tests: referred to early intervention and formal diagnosis (level two assessment)
Screening Red Flags:
·         Does not respond to name
·         Acts as if deaf
·         Does not smile at others
·         Does not point or use other gestures by twelve months
·         No babbling by 12 months or words by 16 months
·         Talks but does not try to communicate
·         Loss of any social or communication skill

I thought that these screening red flags were important to mention because first time parents could be seeing things like this and not thinking anything of it because they don’t have any other children to compare the development to.  I also thought it was important that she distinguished between screeing and assessments.  The screenings are used as a tool to determine whether a formal diagnosis is needed, and I think sometimes that even the word "screening" might be scary for parents.

Dr. Ozonoff talks about the Level Two Assessments and the fact that these should be done by interdisciplinary team because it touches on the following aspects:
·         Diagnosis
·         Intellectual
·         Adaptive
·         Speech-language
·         Medication
·         Functional
·         Psychiatric
·         Educational/academic
·         Neuropsychological
·         Motor, OT
As you can see from the above list, no one person can accurately touch on all of these areas, it is imperative that the Psychologist works with the Pediatrician and the SLP and the OT and so on.  This is the same approach that we talked about with our FBAs; utilizing an interdisciplinary team approach so you can get a more accurate picture of what exactly is going on with the child, what their skill defecits and strengths might be. 

Dr. Ozonoff touched on how to diagnosis: DSM-IV Criteria; developmental history from parents; direct interaction with child; review of records – I think the most important thing here that Dr. Ozonoff touched on was the direct interaction with the child.  I feel like records and getting a history can only take you so far, in order to get an accurate assessment of what is going on with the child you need to come into direct contact with them; how else would you try to get a handle on the different skills they have strengths or weaknesses in, to me this just seems like common sense but it also seems important to point out to everyone in the field who maybe doesn’t feel this way.

Developmental Red Flags are included in the table recreated below; again something that I felt was necessary for everyone to be aware of.

First Year of Life	Second Year of Life	Third Year of Life
General (regulatory) difficulties	Slow language development	Lack of interactive peer play
Less looking at faces and eyes	Lack of imitation	Poor language development (echolalia)
Lack of interest in social games	Lack of joint attention behaviors	Rituals, stereotyped behaviors in some
Poor response to name	Lack of social interest and social play	General delays in some

 At my workplace, we bridge the gap by having team meetings every week with the Head Teacher of the classroom, the Head Teacher of the residence, the nurse, the Behavior Education Team Supervisor, the BCBA (if not the same as the BETS), as well as other staff attend where we discuss each of the students in our unit (usually 6-8 kids) and we talk about any medication changes or issues, upcoming assessments, results of assessments, behavior programs and examine data to see if effective.  In addition to these weekly meetings, we provide quarterly reports to the parents and we keep them updated as to the changes in their child’s life (because we are residential).  Every 6 months, we have a meeting with the school district, the parents, the primary nurse, the head teacher of both the classroom and residence, the BETS, our family services personnel, and we discuss the progress the student has made over the past 6 months towards their IEP goals, we discuss any concerns that anyone at the table has about the child, and we talk about the goals or vision that we have for the child.  It seems to work to keep everyone on the same page while allowing an open atmosphere to really discuss what is going on with the child.