In the childcare industry, there are many challenges and barriers when supporting children with unique needs. The size of the classroom and the ratio of workers may delay the caregivers’ ability to adequately screen and identify the red flags associated with autism spectrum disorder (ASD). Further, some caregivers may not understand the full spectrum of ASD signs and symptoms, which often leads to delays in a diagnosis.
If you have a child in your classroom who has the signs and symptoms of ASD, how can you help? What’s your role? First and foremost, it’s important to understand the barriers that impact the early detection and screening process. Optimal outcomes occur when a diagnosis occurs before the age of three. Some children may have been screened before age 3 and have received a language delay diagnosis, when a more thorough evaluation would have identified ASD.
During well child visits, the Pediatrician may only screen for the obvious signs of ASD. Many Pediatricians or PCPs don’t receive formal training on the DSM-5 diagnostic criteria for ASD. When a Pediatrician takes the “wait and see” approach, the window for early intervention is lost. Further, by the time some children receive a diagnosis, they may be placed on a waitlist for therapy services, and the time spent waiting causes the family to lose valuable treatment time within the critical early intervention window.
As a result, the best approach is to ensure that parents request a comprehensive diagnostic assessment prior as early as possible. Some children receive a diagnosis at the age of 18 months! A comprehensive diagnostic assessment, such as the Autism Diagnostic Observation Scale, Second Edition (ADOS-II) or a neuropsychological (“neuropsych”) evaluation, are conducted by specialists, such as Developmental Pediatricians, Neuropsychiatrists, Neurologists or Clinical Psychologists. A parent may not understand the role of a specialist and may have difficulty navigating the referral process.
When approaching a parent to discuss your concerns, consider these five practices which will help to set the family up for success.
1. YOU are the parent’s trusted advisor.
Parents trust you with their most valuable resource, their child. Many parents don’t know the difference between neurotypical development and delayed social, language and cognitive development. The parents trust you to care for their child, and you spend a considerable amount of time with them. The stronger a relationship that you have with the parents, the higher likelihood that they will hear your concerns and follow through with a more comprehensive screening.
2. Conduct regular developmental screenings.
Similar to mandated reporting regulations, you may be required to complete developmental screenings with your learners. Check with your Director to determine if there are any mandated state reporting laws. It’s important to become familiar with the CDC developmental milestones from birth – age five screening tools. There is an interactive milestones tracker app that allows caregivers to enter the child’s date of birth and track the developmental milestones. The CDC has a wealth of free resources available to support caregivers throughout this process. It’s recommended that you set up an account for each of your students and meet with parents regularly to review the screening. Remember, a yearly physical exam is where most delays are first discussed, so you have 11 months of the year to identify concerns! Some links to these resources include:
- https://www.cdc.gov/ncbddd/actearly/milestones-app.html
- https://www.cdc.gov/concerned
- https://www.cdc.gov/ncbddd/actearly/concerned.html
3. When you bring up the conversation, bring examples of objective measures/data!
When you have specific, observable and objective examples to provide to the parent, they can use this information to seek a diagnosis. Don’t say: “I think you need to have Chucky screened for autism.” Instead, approach it with a different statement, such as “During my monthly developmental screening, I noticed that Chucky speaks about 10 words per day. The CDC developmental milestones indicate that a child his age should have at least 50 words. I’ve been tracking the milestones which I’ve observed, and I’d love to go over each of them with you so we can evaluate if further screening is necessary.”
4. Help the parents understand the difference between AND REQUEST a routine screening and comprehensive diagnostic evaluation.
If the child receives an ASD diagnosis, their medical insurance provider may cover a specific intervention called Applied Behavior Analysis (ABA). ABA is an evidence based, medically-necessary intensive treatment provided for up to 40-hours-per-week. The insurance provider will require a comprehensive diagnostic evaluation prior to covering ABA therapy services. Each insurance company has different requirements for the type of diagnostic evaluation, but the quicker the parent can receive the evaluation and diagnosis, the faster ABA services can occur. Parents should start the conversations with their Pediatricians early, as waitlists for diagnostic assessments are also likely. Parents have the right to a second opinion, and they can request a referral to a specialist through their PCP, or seek one out independently. It may be beneficial for you to have a list of providers that you can refer parents to in the event they need support with identifying who can provide the diagnostic assessments.
5. Provide support, guidance and collaboration throughout the process.
There are many supports that you can use for each child, including (1) visual supports for transitions, (2) breaking down instructions into smaller steps, (3) providing time to respond to requests or instructions, (4) providing prompting or errorless teaching procedures, (5) using peer modeling for social skills, (6) using reinforcement systems, such as token economy systems, positive praise, stickers, and (7) providing an inclusive environment.
Conclusion: ABA Can Help!
Applied Behavior Analysis isn’t only for decreasing maladaptive behaviors. The treatment also includes teaching adaptive skills to children to help them learn the skills they need to thrive in the least restrictive and inclusive environment. ABA programs are supervised by Board Certified Behavior Analysts (BCBAs), who assess, develop and deliver therapy according to the individual needs of the child. Services are delivered where the child requires the most support, often in ABA centers, the child’s home and within the community.
One typically overlooked place is a daycare setting, especially for children who require only moderate level support. Children benefit from having ABA services in childcare settings to provide support, learning, and reinforcement at a place where children spend most of their time.
Other advantages of including ABA support in a daycare setting include:
- access to neurotypical peers to help the child to develop social skills
- collaboration with other providers
- support to daycare staff, and providing services in the least restrictive environment.
If a parent approaches you to ask if their ABA therapist can attend daycare with their child, please consider this option and work with the family to achieve outcomes that are beneficial to all parties.
Note: ABA therapy is a more intensive approach than other disciplines, such as speech or occupational therapy. A speech or OT practitioner may only need to work with a child for 1-2 hours a week. ABA often requires 20-40 hours a week of 1:1 support. This can provide great benefit to daycare providers; it will provide support for your staff for a child with behavioral challenges and allow them to provide more focus to the neurotypical peers in the classroom.
Are you a daycare provider with questions about how you could better support students with autism? FUNdamental Development ABA has a team of highly experienced clinicians who would be happy to speak with you. Reach out to us at www.fundamental-aba.com to learn more!