This is a Guest Post by Lauren Lowry, Hanen Certified SLP www.Hanen.org
A new study shows that an increasing number of children with autism are only being diagnosed with the disorder once they get to school . Since we know that early intervention improves outcomes for most young children with autism , the results of the study point to the need for better early detection. It is hoped that providing therapy at a very young age, when a child’s brain development is most receptive to learning, can alter the course of autism .
There is currently no medical test to diagnose autism. Rather, autism is diagnosed by observing a child’s behavior and looking for specific symptoms. Researchers have been studying the earliest signs of autism in babies and toddlers so that doctors know what to look for, and so that children can get the help they need as soon as possible. By looking back at the home videotapes of young children with autism, some early symptoms have become apparent. Furthermore, because the younger siblings of children with autism are at increased risk (6 to 9%) of developing autism themselves, researchers have studied these siblings and been able to track the development of autism from infancy . What has evolved is a list of early “red flags” or signs of autism that can be seen in children between 12 and 18 months of age.
EARLY RED FLAGS FOR AUTISM
The following are some of the early signs of autism that appear by 12 months of age [3, 5, 6]:
- not babbling – babbling refers to the sounds that babies make before they begin to talk, such as vowel and consonant combinations like “ba”, “da”, and “gee”. Twelve month olds should look at someone while they babble, and take turns babbling with caregivers (like a back-and-forth babbling “conversation”).
- not pointing – such as pointing to ask for things (pointing to the cookie bag up on the shelf) or pointing to get someone’s attention (pointing to an airplane flying by).
- not showing objects to caregivers – 12-month olds hold up interesting objects and show them to their caregivers (as if to say “hey mom, look at this!”). It can be an early sign of autism if a child isn’t showing things to people.
- lack of other gestures – besides pointing and showing, 12 month old children should also be reaching to be picked up, waving, and shaking their head (for “no”).
- lack of shared enjoyment – shared enjoyment refers to a child’s desire to interact with others, just for the sake of connecting. If a child does not seek out this type of interaction, or rarely smiles or laughs when playing with a caregiver, this is a red flag for autism.
- repetitive actions or movements – like spinning a car wheel over and over again, rather than playing with the toy appropriately. Another example would be a child flapping his hands repetitively. Some typically-developing babies do these types of repetitive actions once in a while, but babies with autism demonstrate these actions more often.
- poor eye contact – not looking at caregivers when communicating or playing with them.
- not following an adult’s pointed finger – not looking in the direction of a caregiver’s finger when he or she points to something. For example, a typical 12-month old will look when their mother points to a toy on the shelf.
- paying more attention to objects than people – all children are fascinated with toys and interesting objects. But young children with autism will spend much more of their time with objects than people.
- limited play with toys – a young child with autism may only engage with a small number of toys, or play with just a part of the toy (the wheels of the toy car) rather than the whole toy.
- not copying actions or sounds – not imitating actions like clapping hands, banging on a drum, or people’s speech sounds.
- not responding to his or her name when called – some parents of young children with autism initially wonder if their child is hearing properly, or think that their child is just ignoring them when they call his or her name. Children with delayed language should have a hearing test to rule out a hearing problem. But young children with autism don’t respond when their name is called even though their hearing is fine. This is due to difficulties with paying attention and understanding language.
For toddlers between 18 – 24 months, the following is also a red flag for autism:
- a loss of words, skills, or social connection – this type of regression doesn’t happen with all children with autism. But approximately 20% to 50% of parents of children with autism report that their child lost some of his or her skills during the second year, usually around 18 months of age .
An “ASD video glossary” has been developed by First Signs® and the First Words® Project. Designed to help parents and professionals learn more about the early signs of autism, the glossary shows video examples of young children with autism. This can be a useful tool for parents trying to understand what the early signs of autism look like in “real life”.
WHAT SHOULD YOU (PARENTS) DO IF YOU ARE CONCERNED?
If your child has any of the early warning signs of autism, seek help right away so that s/he can receive the intervention s/he needs as early as possible. Despite the fact that we know more about the early signs of autism, the reality is that many children are still not diagnosed until around age four . Trust your instincts if you are concerned. The earlier a child receives the intervention he needs, the better his outcome will be. If you are concerned about your child’s communication development:
- Talk to your child’s doctor – the American Academy of Pediatrics recommends that doctors screen children for autism at the 18 and 24 month check-ups . However, if you feel that your child has some of the early signs of autism, speak to your doctor as soon as possible.
- See a speech language pathologist – speech-language pathologists are trained to assess communication skills in very young children, including “social communication skills”. These are the types of communication skills affected in autism. Speech-language pathologists are also trained to look for developmental difficulties including autism, and to refer for further assessments with other professionals if needed. Speech-language pathologists are not permitted to diagnose autism.
- Do not “wait and see” – if you suspect that your child is slow in his or her social and communication development, seek help as early as possible. Many treatment programs for very young children with autism help the parents learn how to help their child. The Hanen More Than Words® Program  is for parents of young children with autism, suspected autism, or social communication difficulties. In this program, parents learn how to interact with their child in ways that improve their child’s communication. By using More Than Words® strategies, you can do a lot to promote your child’s development at home. You can learn more about More Than Words here or watch video excerpts from the Program in the Autism Speaks ASD Video Glossary (you will need to create an account to view the videos).
- Blumberg S., Bramlett, M., Kogan, M., Schieve, L., Jones, J., & Lu, M. (2013). Changes in prevalence of parent‐reported autism spectrum disorder in school‐aged U.S. children: 2007 to 2011‐2012. National health statistics reports, 65: 1‐12. Hyattsville, MD: National Center for Health Statistics. Available online: http://www.cdc.gov/nchs/data/nhsr/nhsr065.pdf.
- “Practice Parameter: Screening and diagnosis of autism”, American Academy of Pediatrics website, March 4, 2013,
- Watson, L. & Crais, E. R. (2013). Translating Between Research and Practice in Serving Infants at Risk for ASD. American Speech‐Language‐Hearing Association: Perspectives on Language Learning and Education, 20(1), 4‐13.
- Stone, W. L., McMahon, C. R., Yoder, P. J., Walden, T. A. (2007). Early Social‐Communicative and Cognitive Development of Younger Siblings of Children With Autism Spectrum Disorders. Archives of Pediatric and Adolescent Medicine, 161(4):384‐390.
- Plauché Johnson, C., & Myers, S. M. (2007). Identification and Evaluation of Children With Autism Spectrum Disorders, Pediatrics,120(5), 1183‐1215.
- Zwaigenbaum, L., Bryson, S., Lord, C., Rogers, S., Carter, A., Carver, L., Chawarska, K., Constantino, J., Dawson, G., Dobkins, K., Fein, D., Iverson, J., Klin, A., Landa, R., Messinger, D., Ozonoff, S., Sigman, M., Stone, W., Tager‐Flusberg, H., Yirmiya, N. (2009). Clinical Assessment and Management of Toddlers With Suspected Autism Spectrum Disorder: Insights From Studies of High‐Risk Infants. Pediatrics, 123, 1383‐ 1391.
- “ASD Video Glossary”, 2009, The Florida State University College of Medicine Autism Institute website, March 5, 2013, http://firstwords.fsu.edu/index.php/asd‐video‐glossary
- “Autism and Developmental Disabilities Monitoring (ADDM) Network”, Centre for Disease Control and Prevention website, March 4, 2013, http://www.cdc.gov/ncbddd/autism/addm.html.
- Sussman, F. (1999). More than words – Helping parents promote communication and social skills in children with autism spectrum disorder. The Hanen Centre: Toronto.