Review of CDC’s “Learn the Signs. Act Early.” – Resources For Early Identification of Developmental Disabilities Including Autism Spectrum Disorder

By
Sunita Chhatwani, MSc, MEd
and
Maithri Sivaraman, MSc, BCBA

Although signs of autism spectrum disorder (ASD) may be present by the child’s first birthday, clinical diagnoses are not typically made until age 4. According to a CDC report, 20% of children identified with ASD had records of showing symptoms of autism; however, neither a school nor a clinic classified those children as having autism. Early identification of ASD is crucial, as it means intervention services can begin early and thereby increase potential to make a significant impact on a child’s functioning and future wellbeing. To achieve this goal, the Centers for Disease Control and Prevention (CDC) developed the campaign “Learn the Signs. Act Early.” which aims to improve early identification of children with autism and other developmental disabilities so that children and families can gain access to treatment as early as possible. The “Learn the Signs. Act Early.” webpage provides a comprehensive list of resources that ASAT has summarized for our readers. A brief discussion of and link to each resource is provided below.

Resources and Tools for Parents & Families

Families play an essential role in the identification of developmental concerns because, as parents, they know their child best. The following CDC tools will equip parents and families with better understanding of typical development and possible developmental delays and disorders.

  1. Milestones1: An entire section is devoted to milestones that children should reach from 2 months to 5 years of age, including interactive tools and a Parent Resource Kit to help keep track of the milestones. A free library of photos and videos of developmental milestones are also provided.
  2. What to do if a parent is concerned: A comprehensive list of tips on what a parent should do if there is concern about their child’s development is provided. These tips serve to reiterate the perils of waiting and the benefits of early identification and intervention.
  3. Developmental monitoring and screening: This section lists recommendations and discusses the importance of these practices and the link to early intervention.
  4. Positive parenting: Tips to promote healthy development, safety, and health at every stage of development are provided.
  5. The children’s book, Amazing Me- “It’s Busy Being 3!” is a free children’s book that teaches parents and teachers about developmental milestones and can serve as a fun activity to do with young children.
  6. Create My Child’s Story” is a printed form for parents (a type of child’s resume), that parents can leave with their doctor to explain who the child is within the family and outlines his or her medical history.
  7. In addition, the CDC provides a number of links to other websites with information on developmental milestones.

Training for Early Childcare Providers and Educators

The ‘Watch Me!’ online training is designed for early childcare providers and educators with resources to help one learn about developmental monitoring. Developmental monitoring includes the observation and recording of ways in which a child plays, acts, speaks and moves everyday. This ongoing process can be done by parents and teachers using the milestones checklists and other free resources provided on the CDC webpage. As important as it is for early educators to be aware of the various milestones that a child must attain by a certain age, it is equally important to know what needs to be done when typical development does not seem to occur. This is exactly what the ‘Watch Me’ training addresses.

The course is divided into 4 modules:

  1. Module 1 brings out the importance of educators in the developmental monitoring of a child. A video of a mother recounting her experience during her son’s autism diagnosis highlights the role-played by the preschool teacher who identifies delayed milestones and refers them to a pediatrician. The video serves to emphasize the unique role that an educator plays in monitoring the development of a child by being one of the first people to observe potential delays and the first person that parents would approach with their concerns.
  2. Module 2 is entirely about understanding children’s developmental milestones. Four different categories i.e. socio-emotional, communication, cognition and physical, are introduced and the module includes sample milestones in all domains from birth until 3 years of age. A case study illustrating how to look for milestones and possible warning signs helps put the theory in perspective.
  3. Module 3 is where the trainee learns to ‘Act Early.’ A simple task analysis walks us through the role of the educator in the entire process of diagnosis starting from developmental monitoring until providing referrals to special education services.
  4. Module 4 is all about communication. It aids the educator in planning for conversations with the family regarding concerns about a child’s development. The list of “try” and “avoid” statements and the video model of a teacher discussing her concerns for a child in class are concrete examples of how an educator can suggest a possible developmental delay to a parent.

Training and Information for Health Care Providers

A health practitioner’s role in monitoring a child’s development, identifying and referring for special services is significant as parents usually consult their doctor when they have questions about their child’s development. The CDC estimates that 1 in every 6 children has a developmental delay; this makes it crucial for health practitioners to be sufficiently prepared to conduct screening or make referrals when necessary.

AUTISM CASE TRAINING (ACT)

The Autism Case Training (ACT) courses focus on developmental screening as opposed to the ‘Watch Me’ training that educates the reader about developmental monitoring. Developmental screening is a formal process conducted by doctors, licensed psychologists or teachers with special training and a specific tool is always used. The course has two versions aimed at different groups:

1. For future health care providers: The pediatrics curriculum is designed to educate future health care providers on the fundamental components of identifying, diagnosing and managing autism spectrum disorders. The classroom-based training has 7 modules.

  • Module 1 focuses entirely on the early signs of autism and case studies involving informal consultations at weddings or parties are discussed.
  • Module 2 is all about the diagnosis including information on developmental screening tools, diagnostic tools, screening in the practice setting, recommendations, and myths. The MCHAT-R is discussed in detail, scoring criteria are mentioned and specific information is provided on what needs to be done if the results indicate a low/medium/high risk for autism. The ASAT website already contains a part of this information under Parents and Educators- Screen your Child.
  • Module 3 deals with communicating the results of the screening to the family. Specific steps are listed suggesting a method to deliver difficult information and recommendations are provided on discussing the results with parents who disagree with the screening conclusions and refuse evaluation.
  • Modules 4 and 5 address evaluation and early intervention. These two modules include a glimpse of the various available evidence based treatments and then describe the structure and contents of an Individualized Education Plan (IEP).
  • Module 6 includes a section on maladaptive behaviors, their treatment and the evidencebased indications on pharmacotherapy as a treatment. With more than 400 treatments being used for autism, it is likely that families consult doctors before deciding on a particular intervention. There is an entire section devoted to handling questions about the use of Complementary and Alternative Medicine such as chelation therapy or hyperbaric oxygen therapy.
  • Module 7 provides anticipatory guidance for 3 common challenges observed in children with autism: sleep, feeding, and toilet training.

2. For primary health care providers: The Web-Based curriculum (CE) is a continuing education course which helps primary health care providers to earn educational credits while gaining knowledge and skills to improve early identification of children with autism spectrum disorder and ensure timely and appropriate care. There are 3 modules covering the identification, diagnosis and management of ASD; each module contains two or three case studies based on reallife situations.

There is also an extensive video library consisting of videos of children exhibiting echolalia, difficulty with transitions, reduced eye contact and other ritualistic behavior patterns often observed in children with ASD. Health practitioners can find relevant data and statistics related to ASD, CDC’s latest research on the topic and recent articles published in scientific journals on the site. They can download all the material for free.

All the materials are in English and Spanish and certain materials are available in other languages as well (i.e., Arabic, Korean, Portuguese, and Somali). The CDC has offered the flexibility to translate and customize the materials according to one’s needs upon request and allows sharing material if appropriately cited.

Summing It Up

Overall, the online program is an excellent comprehensive tool for families and other service providers involved in the screening and diagnosis of children with autism. Although the resources are voluminous and can be overwhelming at first glance, the format of the training makes the program easy to follow and accessible to all. If paired with other training such as practice and feedback, CDC’s “Learn the Signs. Act Early.” can be an extremely efficient program to prepare families, educators and health practitioners in the early identification and treatment of autism spectrum disorders.

Footnotes:
(1) Disclaimer from the CDC: “Learn the signs. Act early.” materials are not a substitute for standardized, validated developmental screening tools.

Citation for this article:

Chhatwani, S., & Sivaraman, M. (2016). Consumer Corner: Review of CDC’s “Learn the Signs. Act Early.” Science in Autism Treatment, 13(4), 12-15.

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