Five Early
Signs of Autism
from The
Exceptional Parent - December 6, 2002
For more articles visit
www.bridges4kids.org.
For more
information on Autism,
click here.
Timmy was the perfect baby. Quiet and complacent, at 10 months
he could play by himself for hours, allowing me to read the
paper or do the housework. Unlike our friends' children, Timmy
was so much less demanding of our attention. We just assumed
he was very bright and independent. We began to worry,
however, when his older sister celebrated her 4th birthday,
and Timmy was only a year old. With all the friends and
relatives around, he suddenly seemed withdrawn, preferring to
crouch in a corner by himself, and at times crying as if there
was too much commotion for him. Over the next several months,
we began to notice other signs that concerned us. Timmy seemed
not to notice our comings and goings as much, and by 18
months, still had not spoken a word. We talked to our
pediatrician, but were told that he was likely just a little
slow to talk-boys often are, and he has a big sister who likes
to do things for him. When Timmy still was not talking at 2,
we began to look for other help....
Although autism is usually diagnosed when the child is 3 to 4
years old, parents like the mother above often sense that
something is wrong much earlier. On average, parents start to
worry about their child's development by 18 months of age and
voice some of their concerns to a doctor or another
professional by age 2.
But physicians and professionals are hesitant to diagnose
autism at very early ages. They know that the early
development of children varies, and are often uncertain if a
behavior will persist into being considered atypical, or if
behaviors that should be present will continue to be absent.
If the child is labeled with a problem too early, parents may
reduce expectations for the child and restrict the child's
access to typical experiences and opportunities. Thus,
professionals may take on a "wait and see" stance that delays
diagnosis, and ultimately the commencement of intervention
services.
Although such concerns are valid, the benefits of early
diagnosis vastly outweigh the risks. These benefits include
the relief parents may feel in having their concerns
validated, and in their ability to address the problem as
early as possible. As many studies have now shown, early
intervention is critical for the best outcome in children with
autism, and many believe the earlier the better. Only with a
diagnosis can parents begin to obtain necessary intervention
services for their child.
Given the potential benefits of early diagnosis, is it
possible to reliably diagnose autism before age 2? The answer
is yes. A number of researchers have now studied the early
development of children with autism-a not so easy task given
that the average age of diagnosis in the United States is 3 to
4 years of age.
Early development of children with autism has been studied by:
* screening large numbers of children for autism-specific
behaviors during well-baby checks at 18 months of age;
* asking parents of children with autism to remember back to
whether their child showed certain behaviors at certain
developmental ages;
* and having parents bring in home videos of children
diagnosed with autism when these children had their first or
second birthday parties (which parents often videotape).
From these studies, five distinct areas of development are
flagged for consideration. All parents should consider these
"Big Five" if they suspect that their child may have autism.
1) Does the baby respond to his or her name when called by the
caregiver? Within the first few months of life, babies respond
to their own name by orienting toward the person who called
them. Typical babies are very responsive to the voices of
familiar people, and often respond with smiles and looks.
In contrast, infants later diagnosed with autism often fail to
respond to their own name. That is, when called by name, they
tend to turn and look at the person only about 20% of the time
as found- in the videotaped one year-old birthday parties of
children with autism. They also are often selectively
responsive to sounds. They may ignore some sounds and respond
to others that are of the same loudness. Thus, they may fail
to respond to their parent calling their name, but immediately
respond to the television being turned on. It is not unusual
for parents to suspect their child has a hearing loss.
2) Does the young child engage in "joint attention"?
Near the
end of the first year of life, most infants begin to join with
their caregivers in looking at the same object or event. To
aid in this process of "joint attention", typical infants
begin to shift their gaze from toys to people, follow other's
points, monitor the gaze of others, point to objects or events
to share interest, and show toys to others. These behaviors
have a distinct sharing quality to them. For example, the
young infant may point to an airplane flying over head, and
look to the parent, as if to say, "do you see that!"
In contrast, young children with autism have particular
difficulties in jointly attending with others. They rarely
follow another's points, do not often shift their gaze back
and forth from objects to people, and do not seem to share
"being with" the caregiver as they watch and talk about
objects, people, or events. They also tend not to "show" a toy
to the parent.
3) Does the child imitate others? Typical infants are mimics.
Very young infants can imitate facial movements (e.g.,
sticking out their tongue). As early as 8-10 months, mothers
and infants say the same sounds one after another, or clap or
make other movements. Indeed, imitation is a major part of
such common infant games as pat-a-cake and So Big ("How big is
baby? Soooo big!" as infant raises hands to sky).
Young children with autism, however, less often imitate
others. They show less imitation of body and facial movements
(waving, making faces, playing infant games), and less
imitation with objects.
4) Does the child respond emotionally to others? Typical
infants are socially responsive to others. They smile when
others smile at them, and they initiate smiles and laughs when
playing with toys and others. When typical infants observe
another child crying, they may cry themselves, or looked
concerned. Somewhat older infants may crawl near the person,
pat, or in other ways offer comfort. These latter behaviors
are suggestive of empathy and are commonly observed among
children in the second year of life.
In contrast, children with autism may seem unaware of the
emotions of others. They may not take notice of the social
smiles of others, and thus may not look and smile in response
to other's smiles. They also may ignore the distress of
others. Several researchers have now shown that when an adult
feigns pain and distress after hitting herself with a toy, or
banging her knee, young children with autism are less likely
to look at the adult, or show facial concern.
5) Does the baby engage in pretend play? Someone once noted
that "play is the work of children." Young children love to
pretend-to be a mother, father, or baby, to be a firefighter
or police officer. Although children start to play with toys
around six months or so, play does not take on a pretend
quality until the end of the first year. Their first actions
may involve pretending to feed themselves, their mother or a
doll, brush the doll's hair, or wipe the doll's nose. Nearer
their second birthday, children engage in truly imaginative
play as dolls may take on human qualities of talking or
engaging in household routines. Children may pretend that a
sponge is a piece of food, a block is a hat, or a plastic bowl
is a swimming pool that contains water.
In contrast, the play of children with autism may be lacking
in several ways. The young child may not be interested in
objects at all, paying more attention to the movement of his
hands, or a piece of string. If interested in toys, only
certain ones may catch his interest, and these may be used in
a repetitive way that is not consistent with how most children
would play with the toy. They may be more interested in
turning a toy car upside down and spinning the wheels than
pushing the car back and forth. Overall, pretend qualities are
nearly absent in the play of children with autism under 2
years of age.
It is important to note that in each of the 5 areas we have
flagged, we are most concerned with behaviors that are absent
or occur at very low rates. The absence of certain behaviors
may be more difficult to pinpoint than the presence of
atypical behaviors. But concerns in any of the above areas
should prompt a parent to investigate screening their child
for autism. Several screening measures are now available, and
information from the screener will help to determine if the
parent should pursue further evaluations. If the parent is
convinced their child has autism, then they should seek an
evaluation with an expert in autism. Most likely, this
evaluation will involve an interview with the parents to
obtain a complete developmental history of the child, and
direct observations of the child in different situations.
Luckily, Timmy and his parents were able to get the diagnosis
of autism before Timmy's third birthday. They began intensive
treatment with Timmy, and he made immediate progress. They are
hoping for the best outcome, and feel confident that his early
diagnosis was critical in getting him the help he needs to
reach his potential.
Also, see:
Early
Signs of Autism Spectrum Disorders - A list of early signs of autism spectrum disorders from The Help Group -
a non-profit organization that runs a series of specialized schools in
California for children with autism spectrum disorders. |