One of the most important things you can do as a parent or caregiver is to learn the early signs of autism and become familiar with the typical developmental milestones that your child should be reaching.
Catching autism early makes a huge difference. By recognising the early signs and symptoms, you can get your child the help they need to learn, grow, and thrive.
Many children with autism spectrum disorder (ASD) show developmental differences when they are babies, especially in their social and language skills.
Because they usually sit, crawl, and walk on time, less obvious differences in the development of body gestures, pretend play, and social language often go unnoticed.
In addition to speech/language delays and behavioural differences, families may notice differences in how their child interacts with peers and others.
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What Is Autism?
Autism expresses itself through a spectrum of symptoms. Autism spectrum disorder (ASD) appears in infancy and early childhood, causing delays in many essential areas of development, such as learning to talk, play, and interact with others.
The signs and symptoms of autism vary widely, as do its effects.
Some children with autism have only mild impairments, while others have more obstacles to overcome.
However, every child on the autism spectrum has problems, at least to some degree, in the following three areas:
- Communicating verbally and non-verbally.
- Relating to others and the world around them.
- Thinking and behaving flexibly.
There are different opinions among doctors, parents, and experts about what causes autism and how best to treat it.
There is one fact, however, that everyone agrees on: early and intensive intervention helps.
For children at risk and children who show early signs, it can make all the difference. But no matter your child’s age, don’t lose hope.
Treatment can reduce the disorder’s effects and help your child thrive in life.
Recognising Signs of Autism
Here are some examples of social, communication, and behavioural differences in children with autism.
Keep in mind: one child with ASD will not have the same symptoms as another child with ASD. The number and severity of symptoms can vary a lot!
What Are the Signs of Autism?
The autism diagnosis age and intensity of autism’s early signs vary widely. Some infants show hints in their first months. In others, behaviours become evident as late as age 2 or 3.
Not all children with autism show all the signs. Many children who don’t have autism show a few. That’s why professional evaluation is crucial.
The following may indicate your child is at risk for an autism spectrum disorder. If your child exhibits any of the following, ask your pediatrician or family doctor for an evaluation right away:
Social Differences in Children With Autism
- May not keep eye contact or make little or no eye contact.
- Shows no or less response to a parent’s smile or other facial expressions
- May not look at objects or events a parent is looking at or pointing to
- May not point to objects or events to get a parent to look at them.
- Less likely to bring objects of personal interest to show to a parent
- Many do not have appropriate facial expressions.
- Has difficulty perceiving what others might be thinking or feeling by looking at their facial expressions
- Less likely to show concern (empathy) for others
- Has difficulty making and keeping friends
Communication Differences in Children With Autism
- Less likely to point at things to indicate needs or share things with others
- Says no single words by 15 months or 2-word phrases by 24 months
- Repeats exactly what others say without understanding the meaning (often called parroting or echoing)
- May not respond to name being called but does respond to other sounds (like a car horn or a cat’s meow)
- May refers to herself as “you” and others as “I” and may mix up pronouns.
- May show no or less interest in communicating.
- Less likely to start or continue a conversation
- Less likely to use toys or other objects to represent people or real life in pretend play
- May have a good rote memory, especially for numbers, letters, songs, TV jingles, or a specific topic.
- May lose language or other social milestones, usually between the ages of 15 and 24 months (often called regression)
Behavioural Differences (repetitive & Obsessive Behaviors) in Children With Autism
- Rocks, spins, sways, twirls fingers, walks on toes for a long time, or flaps hands (called “stereotypic “behaviour or stereotypies)
- Likes routines, order, and rituals; has difficulty changing or transitioning from one activity to another.
- May be obsessed with a few or unusual activities, doing them repeatedly during the day.
- Plays with parts of toys instead of the whole toy (e.g., spinning the wheels of a toy truck)
- May not cry if in pain or seem to have any fear.
- It may be very sensitive or not sensitive at all to smells, sounds, lights, textures, and touch.
- May have unusual use of vision or gaze—looks at objects from unique angles.
How Parents Can Spot the Warning Signs
As a parent, you’re in the best position to spot the earliest warning signs of autism.
You know your child better than anyone and observe behaviours and quirks that a pediatrician might not have the chance to see in a quick fifteen-minute visit.
Your child’s pediatrician can be a valuable partner, but don’t discount the importance of your observations and experience.
The key is to educate yourself, so you know what’s typical and what’s not.
Monitor Your Child’s Development.
Autism involves various developmental delays, so keeping a close eye on when—or if—your child is hitting the critical social, emotional, and cognitive milestones is an effective way to spot the problem early on.
While developmental delays don’t automatically point to autism, they may indicate a heightened risk.
Take Action If You’re Concerned.
Every child develops at a different pace, so you don’t need to panic if your child is a little late to talk or walk.
When it comes to healthy development, there’s a wide range of “typical.”
But if your child is not meeting the milestones for their age, or you suspect a problem, share your concerns with your child’s doctor immediately. Don’t wait.
Don’t Accept a Wait-And-See Approach.
Many concerned parents are told, “Don’t worry” or “Wait and see.” But waiting is the worst thing you can do.
You risk losing valuable time at an age where your child has the best chance for improvement.
Furthermore, whether the delay is caused by autism or some other factor, developmentally delayed kids are unlikely to “grow out of” their problems.
To develop skills in an area of delay, your child needs extra help and targeted treatment.
Trust Your Instincts.
Ideally, your child’s doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays.
But sometimes, even well-meaning doctors miss red flags or underestimate problems. So listen to your gut if it’s telling you something is wrong, and be persistent.
Schedule a follow-up appointment with the doctor, seek a second opinion, or ask for a referral to a child development specialist.
Regression of Any Kind Is a Serious Autism Warning Sign
Some children with autism spectrum disorder start to develop communication skills and then regress, usually between 12 and 24 months.
For example, a child who was communicating with words such as “mommy” or “up” may stop using language entirely, or a child may stop playing social games they used to enjoy such as peek-a-boo, patty cake, or waving “bye-bye.”
Any loss of speech, babbling, gestures or social skills should be taken seriously, as regression is a major red flag for autism.
Signs and Symptoms of Autism in Babies and Toddlers
If autism is caught in infancy, treatment can take full advantage of the young brain’s remarkable plasticity.
Although autism is hard to diagnose before 24 months, symptoms often surface between 12 and 18 months.
If signs are detected by 18 months of age, intensive treatment may help to rewire the brain and reverse the symptoms.
The earliest signs of autism involve the absence of typical behaviours—not atypical ones—so they can be tough to spot.
In some cases, the earliest symptoms of autism are even misinterpreted as signs of a “good baby” since the infant may seem quiet, independent, and undemanding.
However, you can catch warning signs early if you know what to look for.
Some autistic infants don’t respond to cuddling, reach, pick up, or look at their mothers when being fed.
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Your baby or toddler doesn’t:
- Make eye contact, such as looking at you when being fed or smiling when being smiled at.
- Respond to their name or the sound of a familiar voice.
- Follow objects visually or follow your gesture when you point things out.
- Point or wave goodbye, or use other gestures to communicate.
- Make noises to get your attention.
- Initiate or respond to cuddling or reach out to be picked up.
- Imitate your movements and facial expressions.
- Play with other people or share interests and enjoyment.
- Notice or care if you hurt yourself or experience discomfort.
Developmental Red Flags
The following delays warrant an immediate evaluation by your child’s pediatrician:
By 6 Months
- Few or no big smiles or other warm, joyful and engaging expressions
- Limited or no eye contact
By 9 Months
- Little or no back-and-forth sharing of sounds, smiles or other facial expressions
By 12 Months
- Little or no babbling
- Little or no back-and-forth gestures such as pointing, showing, reaching or waving
- Little or no response to name
By 16 Months
- Very few or no words
By 24 Months
- Very few or no meaningful, two-word phrases (not including imitating or repeating)
At Any Age
- Loss of previously acquired speech, babbling or social skills
- Avoidance of eye contact
- Persistent preference for solitude
- Difficulty understanding other people’s feelings
- Delayed language development
- Persistent repetition of words or phrases (echolalia)
- Resistance to minor changes in routine or surroundings
- Restricted interests
- Repetitive behaviours (flapping, rocking, spinning, etc.)
- Unusual and intense reactions to sounds, smells, tastes, textures, lights and colours
Signs and Symptoms in Older Children
As children get older, the red flags for autism become more diverse. There are many warning signs and symptoms, but they typically revolve around impaired social skills, speech and language difficulties, non-verbal communication difficulties, and inflexible behaviour.
Signs of Social Difficulties
- They appear disinterested or unaware of other people or what’s going on around them.
- He doesn’t know how to connect with others, play, or make friends.
- He prefers not to be touched, held, or cuddled.
- Doesn’t play “pretend” games, engage in group games, imitate others, or creatively use toys.
- Has trouble understanding feelings or talking about them.
- He doesn’t seem to hear when others talk to them.
- Doesn’t share interests or achievements with others (drawings, toys).
- Essential social interaction can be difficult for children with an autism spectrum disorder. Many kids on the autism spectrum seem to prefer to live in their world, aloof and detached from others.
Signs of Speech and Language Difficulties
- Speaks in an atypical tone or with an odd rhythm or pitch (e.g. ends every sentence as if asking a question).
- Repeats the exact words or phrases over and over, often without communicative intent.
- Responds to a question by repeating it rather than answering it.
- Misuses language (grammatical errors, wrong words) or refers to him or herself in the third person.
- Has difficulty communicating needs or desires.
- Doesn’t understand simple directions, statements, or questions.
- It takes what is said too literally (misses undertones of humour, irony, and sarcasm).
- Children with autism spectrum disorder have difficulty with speech and language. Often, they start talking late.
Signs of Nonverbal Communication Difficulties
- Avoids eye contact.
- Uses facial expressions that don’t match what they are saying
- Doesn’t pick up on other people’s facial expressions, tone of voice, and gestures.
- Makes very few gestures (such as pointing). It may come across as cold or “robot-like.”
- Reacts unusually to sights, smells, textures, and sounds. I may be susceptible to loud noises. Can also be unresponsive to people entering/leaving, as well as efforts by others to attract the child’s attention.
- Atypical posture, clumsiness, or strange ways of moving (e.g., walking exclusively on tiptoe).
- Children with autism spectrum disorder have trouble picking up on subtle nonverbal cues and using body language. This makes the “give-and-take” of social interaction very difficult.
Signs of Inflexibility
- Follows a rigid routine (e.g., insists on taking a specific route to school).
- Has difficulty adapting to any changes in schedule or environment (e.g., throws a tantrum if the furniture is rearranged or bedtime is at a different time than usual).
- Unusual attachments to toys or strange objects such as keys, light switches, or rubber bands. Obsessively lines things up or arranges them in a particular order.
- Preoccupation with a narrow topic of interest involves numbers or symbols (e.g., memorizing and reciting facts about maps, train schedules, or sports statistics).
- Spends long periods watching moving objects such as a ceiling fan or focusing on one specific part of an object such as the wheels of a toy car.
- Repeats the same actions or movements repeatedly, such as flapping hands, rocking, or twirling (known as self-stimulatory behaviour, or “stimming”). Some researchers and clinicians believe that these behaviours may soothe children with autism more than stimulate them.
- Children with autism spectrum disorder are often restricted, inflexible, and even obsessive in their behaviours, activities, and interests.
Common Restricted and Repetitive Behaviors
- Hand flapping
- Rocking back and forth
- Spinning in a circle
- Finger flicking
- Staring at lights
- Moving fingers in front of the eyes
- Snapping fingers
- Tapping ears
- Lining up toys
- Spinning objects
- Wheel Spinning
- Watching moving objects
- Flicking light switches on and off
- Repeating words or noises
Causes of Autism
Until recently, most scientists believed that autism is caused mainly by genetic factors. But groundbreaking new research indicates that environmental factors may also be important in the development of autism.
Babies may be born with a genetic vulnerability to autism that is triggered by something in the external environment, either while they are still in the womb or sometime after birth.
It’s important to note that the environment, in this context, means anything outside the body, it’s not limited to things like pollution or toxins in the atmosphere.
One of the most critical environments appears to be the prenatal environment.
Prenatal Factors That May Contribute to Autism
- I was taking antidepressants during pregnancy, especially in the first three months.
- Nutritional deficiencies early in pregnancy, particularly not getting enough folic acid.
- The age of the mother and father
- Complications at or shortly after birth, including meagre birth weight and neonatal anemia
- Maternal infections during pregnancy.
- Exposure to chemical pollutants, such as metals and pesticides, while pregnant.
More research on these prenatal risk factors is needed, but if you’re pregnant or trying to conceive, it can’t hurt to take steps now to reduce your baby’s risk of autism.
Reducing the Risk of Autism: Tips for Expectant Mothers
Take a Multivitamin.
Taking 400 micrograms of folic acid daily helps prevent congenital disabilities such as spina bifida. It’s not clear whether this will also help reduce the risk of autism, but taking the vitamins can’t hurt.
Ask About SSRIs.
Women taking an SSRI (or who develop depression during pregnancy) should talk with a clinician about all the risks and benefits of these drugs.
Untreated depression in a mother can also affect her child’s well-being later, so this is not a simple decision.
Practice Prenatal Care.
Eating nutritious food, avoiding infections, and seeing a clinician for regular check-ups can increase the chances of giving birth to a healthy child.
Autism and Vaccines
While you can’t control the genes your child inherits or shield them from every environmental danger, there is one essential thing you can do to protect the health of your child: make sure they are vaccinated on schedule.
Despite many controversies on the topic, scientific research does not support the theory that vaccines or their ingredients cause autism.
Five major epidemiologic studies conducted in the U.S., UK, Sweden, and Denmark found that children who received vaccines did not have higher rates of autism.
Additionally, a significant safety review by the Institute of Medicine failed to find any evidence supporting the connection.
Other organisations that have concluded that vaccines are not associated with autism include the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), the American Academy of Pediatrics, and the World Health Organization (WHO).
What to Do If You’re Worried
If your child is developmentally delayed, or if you’ve observed other red flags for autism, schedule an appointment with your pediatrician right away.
It’s a good idea to have your child screened by a doctor even if they are hitting the developmental milestones on schedule.
The Academy of Pediatrics recommends that all children receive routine developmental screenings and specific screenings for autism at 9, 18, and 30 months of age.
Schedule an autism screening. Several specialised screening tools have been developed to identify children at risk for autism.
Most of these screening tools are quick and straightforward, consisting of yes-or-no questions or a checklist of symptoms. Your pediatrician should also get your feedback regarding your child’s behaviour.
See a developmental specialist. If your pediatrician detects possible signs of autism during the screening, your child should be referred to a specialist for a comprehensive diagnostic evaluation.
Screening tools can’t be used to make a diagnosis, which is why further assessment is needed.
A specialist can conduct several tests to determine whether or not your child has autism.
Although many clinicians will not diagnose a child with autism before 30 months of age, they will be able to use screening techniques to determine when a cluster of symptoms associated with autism is present.
Seek early intervention services. The diagnostic process for autism is tricky and can sometimes take a while.
But you can take advantage of treatment as soon as you suspect your child has developmental delays.
Ask your doctor to refer you to early intervention services. Early intervention is a federally funded program for infants and toddlers with disabilities.
Children who demonstrate several early warning signs may have developmental delays.
They will benefit from early intervention to meet the full criteria for an autism spectrum disorder.
In other words, there is more risk involved in the wait-and-see approach than in receiving early intervention.
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