Tornadoes. Tooth-brushing. Being told “no.”

What upsets you?

At Children’s Village, counselors use a chart to help autistic children communicate their feelings. At the top of the scale is a picture of a red face with steam coming out of the ears — the face of someone who is “out of control.” At the bottom is a happy face, showing someone who is feeling “just right.”

“A lot of times our kids are better with visual cues,” said speech pathologist and counselor Cindy Carroll.

The “five-point scale” is just one example of the multi-disciplinary approach providers are using more and more to work with autism spectrum disorders, or ASDs.

Developing effective treatments and teaching methods is increasingly important as autism is experiencing a dramatic rise. A few weeks ago, a study by the Centers for Disease Control and Prevention found that in the U.S., about 1 in 50 children ages 6 to 17 had been diagnosed with some form of autism in 2011-12.

That’s a two-thirds increase from the CDC’s last report, which was based on 2008 numbers and said autism affected about 1 in 88 kids.

Applying that prevalence rate in Yakima County means about 925 children are thought to be on the autism spectrum, according to estimates by Children’s Village.

“One in 50 is a big number,” Carroll said. While acknowledging that children on the low end of the spectrum face many challenges, “We like to focus on abilities of children, rather than disabilities.”

At the top of the spectrum, the term can describe children who are very high-functioning and can be in mainstream classrooms. Those on the other end need constant special education and supervision.

In Yakima County, Children’s Village provides the overwhelming bulk of services for families with autistic children. It offers support groups for parents to share ideas, speech therapy, counseling and a multi-disciplinary diagnostics team to identify specifically where each child falls on the spectrum.

This year, the diagnostic clinic will be able to see 72 children.

Children’s Village is a collaboration between Yakima Valley Memorial Hospital, Yakima Valley Farm Workers Clinic, The Memorial Foundation and Comprehensive Mental Health.

While the autism professionals are working to expand services, as of now, parents from all over the Valley still have to drive to Yakima for appointments and programs, which means the Lower Valley is underserved.

“We have sporadic services in the Lower Valley, but I think we could do a little more of a coordinated effort of getting services closer to families,” said Dr. Diane Liebe, medical director of Children’s Village and a neurodevelopmental and behavioral pediatrician who specializes in autism. “We are lacking therapists in our community that do (specialized approaches).”

While there is no individual test for autism spectrum disorder, the current diagnostic manual says that to be termed autistic, a child must have impairment in communication and socialization, and must show restrictive or repetitive behaviors or interests.

Some kids present symptoms of autism early — not making eye contact, using repetitive motor mannerisms, not speaking — while others aren’t identified until they reach school age and the social impairment becomes more pronounced, Liebe explained. Higher-functioning kids are harder to diagnose.

Providers and educators must have specific training to effectively treat and work with kids on the spectrum, Carroll said.

“Nationwide, they’re trying to catch up with the newest research and techniques,” she said. “We have all these kids coming into our systems, and in order to support these kids, some of these newer intervention techniques are very helpful, and not everybody has those techniques in their toolbox.”

Woven into those techniques is a growing focus on “cross-training.”

“You become ... very much a hybrid, drawing upon all your friends in counseling, psychology, occupational therapy, speech and language pathology,” Carroll said. “It’s a cross of medical and educational models.”

Olejeona Jeffrey’s 3-year-old son, Derrius, was officially diagnosed Wednesday, but the family has been receiving services for several months. Jeffrey says working with the providers is like “the biggest sigh of relief.”

“When you deal with somebody who does have special professional training in autism — like we have our speech therapist — that’s make it or break it,” she said.

“My son has had so many amazing breakthroughs. ... She’s provided us with a light at the end of the tunnel and a path and a way to get where we need to go.”

For Derrius, visual tools are crucial. Though he knew all his letters and numbers by 18 months, he was almost entirely nonverbal before going to Children’s Village. Now, a combination of sign language and picture cards help him communicate, and he’s able to speak aloud more.

Jeffrey says she went into “protective mode” when they first suspected Derrius might be autistic, because she was afraid of how he would be labeled. While the Parent to Parent group has helped her realize that “our not-normal is normal,” she feels the general public has a long way to go.

“I think that there’s an overall lack of awareness,” she said. People need to learn more about the disorder, she said, and be more patient with children who are on the spectrum.

In addition to providing more training for parents and professionals, Liebe said Children’s Village wants to develop more programs for older kids.

“We have pretty reasonable services for the younger kids, but it’s variable for the older kids,” she said. Teens need programs to give them social coaching, provide them with opportunities for social interaction, and help them transition to adulthood.

“All of those pieces are a little bit lacking,” she said.

Unique to Central Washington is the autism education coordinator position at ESD 105. Sharon Loudon works with schools, going into the classroom to observe students and making recommendations to the staff on how to better accommodate those students.

“That’s one thing that Yakima really has going for it,” Liebe said. “Because we are a limited size community, we can work directly with the schools, and the schools are great to work with around here.”

The community is “evolving,” Carroll said.

“We know we have some really great foundational services, and we need to continue to collaborate to build the education,” she said.

• Molly Rosbach can be reached at 509-577-7728 or mrosbach@yakimaherald.com.