April is Autism Awareness Month, and today we’re sharing an article from our April issue on detecting early signs of autism. There are lots of local resources available for parents of children with autism; in Ohio, Help Me Grow provides early intervention services for children with developmental needs under age 3. If you have any questions or concerns, we recommend families first talk with their pediatricians.
Parenthood has always come with plenty of questions: Is my child growing normally? Is he getting enough sleep? Is she meeting her nutritional needs? But today’s moms and dads may also be asking a question previous generations did not: Could my child have autism?
According to the Centers for Disease Control and Prevention, one in every 68 children is diagnosed with autism spectrum disorder (ASD.) A government survey in 2015 puts the rate even higher at 1 in 45 children.
The developmental disorder is being detected earlier and earlier, sometimes even before babies have their first birthday, thanks to more public awareness and education campaigns. Spotting autism is far from an exact science, however. Early warning signs can be tricky to discern from typical phases of childhood development, and they vary in severity from child to child.
“Diagnosing an autism spectrum disorder is harder to do before age 2, especially because we’re looking for the absence versus the presence of certain behaviors and skills, but it is possible and ideal, really,” says Lauren Jones, a psychologist with Hamilton County Developmental Disabilities Services. “Early intervention is so important, because we know it can give us much better long-term outcomes, in terms of developmental progress and lifetime cost.”
While some behaviors are commonly associated with kids on the spectrum – such as hand flapping or tiptoe walking – experts also encourage parents to observe how their child learns, communicates and interacts with others, which are key areas in which children with autism often struggle.
Here are some early red flags that may warrant a professional evaluation:
While we typically equate communication with talking, deficits in this area can be spotted well before a child begins to speak. Pointing, babbling, smiling and making eye contact are all forms of subtle, nonverbal communication between child and caregiver, and a lack of these skills can be an early indicator of a problem.
“We look for smiles toward people during those first few months and eye contact with mom while being fed,” Jones says. “Six-month olds are laughing, responding to sounds with their own sounds, and showing affection with the people who care for them. Around 9 to 12 months old, you really start to see that back and forth interaction, exchanging sounds, copying facial expressions, looking where you point and playing peekaboo.”
Once speech begins, a typically developing child should have several words in his or her vocabulary by 18 months, and will likely use multiple-word phrases like “I go now” or “my ball” by the age of 2.
For children on the autism spectrum though, this is when a language deficit can begin to show. They are more likely to use more grunts and sounds and may just have words for “no” or “mama.” Parents may find that the child only communicates when he or she needs something. For example, a typically developing child will bring a toy elephant to a parent and say, “Elephant!” But for a child with autism, they will often only interact if they need the parent to get more toy animals or if the parent tries to take the animal away. Any other interaction about the toy will be from the parent to the child, and it won’t be conversational in nature. If a child does acquire new words but then suddenly stops using them, this can also be an important warning sign.
Trouble with social cues
Another area of major difference between typically developing children and those with autism is the need for and interpretation of social cues.
Imagine a child, between 18 months and 2 years old, waiting with his mother to see the pediatrician. When the doctor comes in, a typically developing child will look at the parent and then at the doctor to observe how his mother is reacting. Is mom smiling? Is she tense? The child will respond to the parent’s facial expressions, perhaps hugging her closer.
A child with autism may not recognize that the person is in the room at all, or recognize the person is present but be interested in them only to see if they have something he or she wants, like a toy.
Similarly, if another person is in the room and a ball falls, a child with autism might go over and investigate the action, but he or she likely won’t take part in any social interaction, like making eye contact with or responding to questions from the other person about what happened.
“We want to see how kids are interacting with the world around them and how much they’re interested in other people,” Jones says. “Parents are sometimes concerned their child might have a hearing impairment because they don’t respond to sounds, especially familiar voices or to their names when called. When no hearing problems exist, this can be a red flag for autism.”
Difficulty with imaginative play
This lack of interest in social interactions can also impact how children with autism play.
Children on the spectrum may be more interested in examining the individual features of toys – wheels, buttons, sounds – rather than playing with the toy in a typical way. For example, a child with autism might look at the wheels of a toy car spin, or open and close the door for hours on end but never push the car from one place to another while making the sound of a motor.
Likewise, common imaginative social play among preschoolers, such as cooking and eating pretend food together, do not come naturally for children with autism.
“They’re around other kids, but they don’t want to play with the other kids, and you see that they don’t want to pretend or play in group games either,” explains Greg Marischen, Center Director of Brain Balance of Cincinnati, which integrates sensory motor training and cognitive activities in its therapy for kids with autism. “They’re often disconnected from their surroundings because they can’t interpret what’s happening.”
Lack of imitation/ no passive learning
Because of their intense focus and ambivalence to social interactions, children with autism don’t learn through observation and imitation the way most children do.
As any parent of a typically developing child knows, kids are watching and listening to us all the time. Even when we don’t realize it, they repeat back words, copy mannerisms and pick up details about the world around them.
For example, a 2-year-old may look in the refrigerator and say, “I want this” while pointing at the yogurt. He doesn’t have a label for the snack yet, but he knows he has experienced it and that he liked it. For children with autism, skills like requesting something or imitating an action require repeated academic training to learn.
“Once the child is 3 or 4 years old, it’s difficult when they don’t have any pragmatic skills, like understanding body language, facial expressions or slang,” Marischen says, adding that because nonverbal communication is so difficult for kids with autism, they are very literal in how they interpret the world.
Engaging in repetitive or ritualistic behaviors can be another sign to evaluate for autism. These behaviors can involve motor movements or vocal sounds, including actions like hand flapping, flicking fingers and tiptoe walking, or self-injurious behavior, such as repeatedly banging one’s head against the wall. Having a fascination with the repetitive movement of objects also qualifies.
As an example, picture a group of children playing in a sandbox. When something interesting happens across the yard, most children will get up to go check it out. But a child with autism may not even notice, instead staying in the sandbox to watch the flow of sand pouring out of a cup over and over again.
A child with autism might also spend a significant amount of time seeking sensory input, such as wedging themselves into tight spaces, slamming into objects or people or spinning in circles. While typically developing children might exhibit these behaviors near bedtime when they’re wound up and overtired for example, children with autism will engage in these actions for hours if allowed.
Extreme sensitivity to environment
Some children with autism may be extra sensitive to the sights, sounds and smells of their environment. Others are averse to physical interaction of any kind. Parents of babies and toddlers with autism often report that their child only stops crying if he or she is put down and left alone, the opposite of what most young children would want.
Similarly, it may be a red flag if minor changes to the child’s environment, such as moving a piece of furniture, changing the light source or playing a game in a different sequence, cause major distress.
Experts stress that autism is a spectrum disorder, so no two children will present characteristics in exactly the same way. Still, these red flags are some of the basic ways in which autism can affect how a child communicates, interacts and learns new skills.
The earlier parents and doctors pick up on a potential problem, the sooner early intervention can begin closing the gaps. “Others might say, ‘Oh don’t worry about it. She’ll grow out of it,’ or ‘Let’s just wait and see,’ but those major red flags should not be ignored, because it’s easier to address them the younger kids are,” Jones stresses. “It’s important to trust your own parental compass, and if you think something is not right or not happening as it should, be persistent in getting those developmental screenings.”
Parents seeking information can refer their own children to Help Me Grow, Ohio’s early intervention service that can identify and provide intervention for children with developmental needs under age 3.