With increased awareness of autism, as exemplified by recent Congressional testimony, there has come a greater need for services. The

Fay J. Lindner Center for Autism offers the significant medical resources of the North Shore-LIJ Health System through a coordinated Health System-wide Autism Steering Committee, so the patient and family are provided a comprehensive and integrated treatment plan.  Comprehensive evaluations at the center include psychiatric/developmental, psychological, speech/language, psychopharmacological and behavioral assessments.

Behavioral Intervention
People with autism and other developmental disorders often develop problem behaviors that can hinder successful functioning in school, at home, and in the community.  These problem behaviors can be ameliorated by successful identification and treatment, achieved through systematic assessment and comprehensive intervention.  By diminishing challenging behaviors and replacing them with more functional and appropriate behaviors, we can promote the independence of the child with autism and help improve their overall level of performance. 

We stress the importance of parent involvement in the management of children’s behaviors and include families as valued participants in intervention planning and implementation, knowing that without parent involvement, we cannot truly succeed.  As part of our effort to fully integrate services, we utilize a cross-agency team to address needs across home, school, and community by providing home- and school-based behavioral interventions. 

Whenever possible, home-based behavior interventions are coordinated with school-based behavioral services to ensure continuity and generalization across settings.  Through the integration of methodologies, we are able to provide a person-centered approach, which is individually tailored to ensure success.

Our positive behavior approach promotes the social, adaptive, and behavioral functioning of children and adults with autism and other developmental disorders by identifying and modifying environmental factors and events that precipitate and maintain challenging behaviors.  We believe strongly in the inclusion of family members, teachers, and community supporters in the planning and implementation of behavioral interventions, thereby promoting the maintenance and generalization of treatment effectiveness across individuals and naturalistic environments.

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Community Training
The Community Training component at the Center for Autism is geared toward Schools, Libraries, Community Organizations, Parent Groups, Health Care Agencies and others.  We offer a team approach to education in Autism Spectrum and other Developmental Disorders, behavioral training, parent and family perspective as well as differential diagnosis of Autism Spectrum Disorders on a half-day or full day basis.

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Comprehensive Assessment
Overview of Comprehensive Assessment
The assessment of children and adolescents suspected of manifesting autism and pervasive developmental disorders is a complex process that requires the participation of a transdisciplinary team of specialists working closely together in an effort to develop a unified diagnostic profile and an integrated set of treatment recommendations. 

Individuals with autism spectrum conditions experience impairments across a range of developmental domains, all of which must be addressed if a successful treatment plan is to be developed. Careful attention must be paid to social, communicative, cognitive, adaptive, affective, and behavioral lines of development.  Treatment planning must be integrated and cohesive, not piecemeal and isolated.

Consistency must be maintained in all social environments since individuals with autism are highly state-dependent in their learning, often failing to apply what they learn across settings and individuals.  Therefore, persons with autism must be understood and approached in an integrated fashion, as whole individuals. For example, speech and language therapy, behavioral strategies, social skills training, and sequential/temporal processing interventions must be delivered throughout the entire day (not simply in individual therapy sessions). This requires close communication and collaboration among members of the assessment/treatment team, parents/caregivers, and teachers/educational staff members.

All too often, children and adolescents with autism are evaluated by each specialist individually, in different locations and at different times. Since little communication typically occurs among the specialists, repetitive and/or discrepant formulations and recommendations are presented in separate reports that are difficult (if not impossible) to rectify and integrate into a consistent and meaningful treatment plan.

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 The Assessment Process consists of:

• A thorough review past history, prior evaluations, symptom profile, and school functioning
• Developmental, medical, psychosocial, and family histories
• Previous evaluations (developmental, neurological, genetic, psychiatric, psychological, speech and language, etc.)
• School reports indicating curricula, academic performance, special services, social behavior, recent Individual Educational Plans, etc.
• Informant (parent and teacher) questionnaires addressing affective and behavioral functioning across settings (home, community, and school)
• Past and present treatment interventions and educational strategies and their effectiveness 
• A diagnostic assessment that includes specialized instruments 
• The Autism Diagnostic Interview – conducted with parents/caregivers
• The Autism Diagnostic Observation Schedule – conducted with the child/adolescent 
• Psychological or Neuropsychological Testing  
• Developmental or Intelligence testing (including nonverbal ability)
• Achievement testing
• Specific neuropsychological testing
• Assessment of adaptive functioning 
• Speech and Language Assessment 
• Measures of basic receptive and expressive language
• Specific measures of language pragmatics and semantics
• Articulation testing 
• Functional Analyses of Behavior 
• Specialized assessments for co-morbid neuropsychiatric conditions (e.g., tic and movement disorders, ADHD, obsessive-compulsive symptom profiles, phobic, generalized, and social anxiety, mood disorders, etc.) and determination of the potential efficacy of psychopharmacological treatment 
• Neurological examination (if indicated) 
• Team meetings to plan the assessment, discuss findings, develop case formulation, and outline treatment recommendations 
• Feedback and treatment planning session with parents/caregivers 
• Scoring of assessments and preparation of an integrated report

Counseling – individual, couple, and/or family
Counseling at the Fay J. Lindner Center for Autism encompasses education as well as support. Our staff offer several parent and family-oriented group training workshops in addition to individualized training opportunities that are individually tailored to meet the needs of parents and care providers of individuals with autism spectrum disorders and other behaviorally-exhibited disabilities. 

Our Master's Level Social Workers have expertise in the areas of Family Issues, Community Referrals, Behavioral Interventions, Educational Resources as well as State and Local Entitlements.  Our staff is available to train  in-home, at schools, and at the Center.  In addition their  expertise lies in the areas of family isssues, community referral, behavioral intervention, educational resources as well as state and local entitlements.

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 Early Childhood Services
The broad range of services provided by the Fay J. Lindner Center for Autism includes those specifically designed for young children with autism or related developmental disorders.  These services include comprehensive evaluations (psychiatry, psychology, speech/language, and social work), program consultation, family education and training, parent support, and service coordination. 

We also provide family-centered home- and center-based psychological services to promote engagement and social communication using a developmental/behavioral approach.  We are an approved Early Intervention provider.

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 Psychiatric Assessment
Psychiatric evaluations focus on establishing or confirming the diagnosis of an autism spectrum condition, in addition to co-occurring neuropsychiatric syndromes that impair affective and behavioral functioning, such as, attention deficit syndromes, anxiety disorder profiles, mood disorders, obsessive-compulsive symptoms, as well as movement and tic disorders.

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 Psychological Assessment
To come

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Psychopharmacology Consultation/ Medication Management   
When clinically indicated, medication trials will be conducted.  Valid and reliable methods of clinical change will be used by clinicians, teachers, and parents.  Whenever advantageous, combined behavioral – psychopharmacological treatment interventions will be provided.

In addition, families will have the opportunity to participate in federally funded medication research protocols in which the Center is involved.

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School Consultation
The School consultation program at NSLIJ through the Fay J. Lindner Center for Autism provides support, leadership and training for all school personnel, and families.  Our highly trained Special Educators and Board Certified Behavioral Consultants provide not only behavioral consultation but also educational consultation, hand on teaching opportunities and staff trainings. 

We work with the IDT team through all phases of each student’s highly individualized Behavior Intervention Plans, from FBA’s to data collection.  We work in the environment of the school making each plan we devise a good fit into the school  environment. 

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School Programs
We provide a variety of programs to all grades within the school system including but not limited to:  individual and group behavioral programming, educational modifications, setting up and structuring classrooms for students with Autism and developmental disabilities, programs to teach peer mentoring, staff training for all levels, assistance with specific curriculum development.

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Programs for agencies
We provide staff training, behavioral programming to individuals and groups, goal development (according to OMRDD guidelines) and support for behaviorally challenging consumers.

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Social Work Services
It is our Philosophy at the Fay J. Lindner Center for Autism that the family is the most essential component of the child’s life. Therefore our Family Service Department comprised of Masters Level Social Workers play a key role at all times in all interactions with families.

Social Work Services at the Fay J. Lindner Center for Autism includes the following:

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 Speech Language Assessment

Whether pursuing speech and language therapy, or altering current speech and language goals and objectives based on a child’s performance, a thorough assessment of an individual’s language ability is essential to securing a therapist (and services) who will address your child’s specific communication needs. 

More importantly, a speech and language assessment should be individualized with regard to the types of standardized test batteries selected based on parent/educator’s concerns, previous testing (in both cognitive and speech and language domains), and the cognitive and linguistic profiles of any given subtype of autism, such as Asperger, High-Functioning Autism (HFA) PDD-NOS and Autistic Disorder (also known as classic autism).  The core impairment in autism spectrum disorders is in the realm of social-emotional understanding and social communication. 

Communication deficits can rage from a delay or lack of speech to the excessive use of stereotyped language and the inability to initiate of sustain conversational speech depending on the ASD subtype. 

A comprehensive speech and language evaluation, administered by a qualified speech and language pathologist with expertise in the field of autism (and the ability to accurately interpret normative data in terms of relative strengths and weaknesses and how they affect one’s ability to engage in social communication), can identify strengths and weaknesses in the areas of form, content, and use of language and provide differential diagnosis of secondary (to autism) language disorders such as:

• Broad based language disorder equally affecting the areas of form, content and use of a person’s language to comparable degrees

• Selectively affects the areas of content (particularly meaning and intent) and use of language (otherwise known as pragmatic language) despite the presence of average to superior form or expressiveness. 
• More common in children with Asperger Syndrome and HFA (and may not be as apparent or even detected if the proper assessment tools are not used)

Stacey Kanin, clinical-fellow speech language pathologist and Gina-Marie Muscillo-Moravcik , a speech pathologist, are pleased to offer speech and language evaluations for children and adolescents.  These evaluations typically entail standardized testing in the areas of form, content, and pragmatics.  Specific tests are chosen based on several factors including the patient’s age, primary diagnosis (various subtypes of ASD), parental concerns, academic functioning/educator’s concerns, and a review of previous evaluations and IEP’s (1-2 years prior). Recommendations as to academic modifications, speech and language therapy, specific language goals and objectives, therapy materials and programs, and social skills groups are provided in the final report.  Please note that AAC evaluations are not conducted at our facility.  We would be please to provide you with recommendations as to who to contact if you are in need of such an evaluation.

Semantic-Pragmatic Language Evaluation
 
A semantic-pragmatic language evaluation, administered by a qualified speech and language pathologist with expertise in the field of autism (and the ability to accurately interpret normative data in terms of relative strengths and weaknesses and how they affect one’s ability to engage in social communication), can identify strengths and weaknesses in the areas of  language known as content and use and provide differential diagnosis of a secondary (to autism) language disorder known as semantic-pragmatic language disorder. This disorder:

Rapin and Allen described a “semantic-pragmatic syndrome…in which there is fluent and syntactically complex expressive language, but the child has problems in understanding discourse.”  Children with deficits in semantics and pragmatics can have impairments in one or more of the following higher-order language skills: figurative language, rules of social language (conflict resolution, generating multiple solutions, debating/disagreeing, accepting consequences, offering compromises) conversational skills (personal introductions, topic initiation, topic maintenance, turn taking, conversational repairs, self-monitoring skills, etc.), and presupposition or perspective taking (incorporating the thoughts and ideas of the listener into conversations, taking their feelings and emotions into account). In the context of academics, children with the aforementioned deficits will have difficulty with assignments that require descriptions of: social characteristics, similarities and differences, overall themes, social nuisances, cause and affect vs. correlation, as well as, comprehension  and use of: idioms, figurative language, and overall problem solving abilities including sequencing and predicting.  
 
Many people with a HFA or AS have not been able to qualify for speech and language services in the school or have been discharged from these services due to average to superior performance on the assessments utilized. A majority of tests used in schools districts assess basic area of language including form and speech production or intelligibility. However, many of these students require speech and language therapy to focus on areas of higher-order language, areas that are often not evaluation in a school-based assessment. It should be noted that speech-language pathologists working in school environments are only allotted a small amount of time for testing by their school districts. Therefore they do not have the time that is often needed to conduct comprehensive assessments of all areas of language. A center-based semantic-pragmatic language evaluation allows for a more in-depth evaluation of the language areas affected in HFA and AS.  
 
Gina-Marie Muscillo, speech language pathologist and Stacey Kanin, clinical fellow-speech language pathologist at the Center for Autism, are pleased to offer center-based independent semantic-pragmatic language evaluations for children, adolescents, and adults with HFA, AS, or symptoms of this disorder. Potential candidates for this assessment include people with basic conversational skills (using basic language to talk with others). This type of evaluation typically involves 3-4 hours of standardized testing in the areas of content and use.  Specific tests are chosen based on several factors including the patient’s age, primary diagnosis, parental concerns, academic functioning/educator’s concerns, and a review of previous evaluations and IEP’s (1-2 years prior). The tests concentrate on figurative language, inference, ambiguity, contextualized meaning, social judgment, and problem-solving using open-ended questioning and at times visual stimuli. Informal observations are also made regarding a client’s understanding and use of supralinguistics including sarcasm, irony, and humor. The presence of a semantic-pragmatic language disorder is determined after an in-depth review of: previous evaluations across disciplines (speech and language, social work, psychiatry, psychology), current IEP, and results from the semantic-pragmatic language evaluation. Tests Recommendations as to academic modifications, speech and language therapy, specific language goals and objectives, therapy materials and programs, and social skills groups are provided in the final report.  Information obtained from this evaluation may warrant a recommendation for further diagnostic testing.

For people over the age of 21 interested in a semantic-pragmatic language evaluation:

At this time standardized testing of higher-order language, is not currently available for people over the age of 21. A semantic-pragmatic language disorder can still be diagnosed by a speech-language pathologist. The testing used for people under the age of 21 is implemented and assessed subjectively by the speech-language pathologist. Informal observations and age-equivalents are also utilized to determine the presence of the disorder.

For more information or to schedule an appointment please contact Gina-Marie Muscillo-Moravcik or Stacey Kanin at the Fay J. Lindner Center for Autism 516-802-8600.

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 Speech Language Treatment

In order to address your child’s specific communication needs, a Speech-Language Pathologist will conduct a thorough review of your child’s recent speech and language assessments, cognitive assessments, and IEP prior to the initiation of treatment. The therapist will then meet with you in order to collaborate on the development of appropriate and individualized goals for your child.

Speech Language Treatment Services at the Fay J. Lindner Center for Autism focus on the appreciation and/or use of the following:

• Form
  • Syntax, grammar
  • Morphological Awareness (e.g. prefixes, suffixes)
  • Phonological Awareness (e.g. blending, segmenting, rhyming of sounds)
  • Articulation (PROMPT therapy is available through a trained therapist)

• Content
  • Semantics (Vocabulary)

• Use
  • Pragmatics (social judgment)
  • Social Skills
  • Higher-order language (i.e. inference, figurative language, sarcasm)

• Joint Attention

Treatment is administered by a qualified speech and language pathologist with expertise in the field of autism. Sessions occur at the Center for Autism for a clinical hour (45 minutes) 1-2x weekly depending on the needs of your child and clinician availability. If you are interested in obtaining speech and language therapy at the Center for Autism please be advised that previous evaluations and a recent IEP will be requested prior to the initiation of treatment.

Stacey Kanin, a clinical fellow-speech language pathologist, and Gina-Marie Muscillo-Moravcik, a speech language pathologist, are pleased to offer speech and language treatment for children, adolescents, and adults.  Treatment goals will be created based on your child’s individual needs and current areas of concern.

Communication Based Social Skills Group

The understanding and use of appropriate social skills is often difficult for children with autism spectrum disorders. The Center for Autism offers communication based social skill groups for children and adolescents with autism spectrum disorders. Recent evaluations and IEP will be requested upon initial contact. Following a review of this information, a social skill screener will be conducted. This 15-20 minute screener is conducted with you and your child to gain more information about your child’s current skill level. Groups will be formed based on a child’s communication and cognitive ability level and common areas of concern.

Current Communication Based Social Skills Groups focus on the following:

• Higher-order language skills
  •  i.e. inference, figurative language, predicating, humor, sarcasm, ambiguity
• Appropriate social interaction between peers
  • Initiating and maintaining conversations, turn-taking, staying on topic, conversational repairs
• Presupposition or perspective taking
  • Incorporating the thoughts and ideas of the listener into conversations
• Nonverbal language
  • Gestures, facial expressions, proximity, eye-gaze

Stacey Kanin, a clinical fellow speech language pathologist, and Gina-Marie Muscillo-Moravcik, a speech language pathologist, are pleased to offer communication based social skills groups.

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Support Groups/ Family Support and Education
A Support Group for families of children who are newly diagnosed is held periodically. This group will focus on the emotions that are encountered as your child is diagnosed with a developmental disability. We will also share information that is often overwhelming and confusing at this difficult time. Guest speakers will present on specific topics of interest.  Please contact the Center for further information.

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