Early Signs In Infants And Toddlers
Early signs of autism can often be detected in infants as young as 6-18 months. For example, if a baby fixates on objects or does not respond to people, he or she may be exhibiting early signs of an autism spectrum disorder.
Older babies and toddlers may fail to respond to their names, avoid eye contact, lack joint attention , or engage in repetitive movements such as rocking or arm flapping. They may play with toys in unusual ways, like lining them up or focusing on parts of toys rather than the whole. Parents who notice these signs, or are concerned their children are not meeting developmental milestones, should contact their pediatricians and request a developmental screening. The American Academy of Pediatrics recommends routine screening of all infants for autism as part of 18-month and 24-month well-baby examinations.
Early diagnosis and early intervention are critical. Studies show that about half of children with autism who are in an evidence-based early intervention program from age 3-5 can gain enough skills to be mainstreamed for kindergarten. There are now evidence based interventions for babies as young as 12 months old, and studies are underway to design treatments for 9 month old babies at risk for autism.
Learn more about the early warning signs of autism including milestones for development up to age 5 and what to do if you are concerned.
Restricted Or Repetitive Behaviors Or Interests
People with ASD have behaviors or interests that can seem unusual. These behaviors or interests set ASD apart from conditions defined by only problems with social communication and interaction.
Examples of restricted or repetitive interests and behaviors related to ASD can include:
- Lines up toys or other objects and gets upset when order is changed
- Repeats words or phrases over and over
- Plays with toys the same way every time
- Is focused on parts of objects
- Gets upset by minor changes
- Has obsessive interests
- Flaps hands, rocks body, or spins self in circles
- Has unusual reactions to the way things sound, smell, taste, look, or feel
How To Recognize The Early Signs Of Autism In Toddlers
The language will be stilted in nature- usually but not always. With kids who are showing signs of regression, they will typically have language delays. Keep in mind that all of these symptoms may not be present in all children with autism.
Children with autism can also be less aware of stimulus in the external environment. This could cause issues when it comes to sensing pain. Your child may have incredible sensitivity to pain or have a higher pain threshold. In some cases, they are unable to recognize their parents after the first few months of life.
Autism in children can lead to toilet training problems.
Autism also has the possibility to hamper the childs ability to smile and show emotion and can end with behaviors, such as walking on tiptoe, sensory meltdowns, unpredictable behavior, strange postures, staring at hands, flapping hands, and rocking back and forth.
The above behaviors are often referred to as stimming though not all children will display them.
They may also prefer playing alone, remain aloof, and become segregated from other children. Autism in children may cause the child to become obsessed with one action or topic, and extreme confrontation to change of any kind.
An autistic child may want to set up a separate environment for themselves and also may establish their own behavioral patterns. They may not be interested in playing alongside family members close to their age, but could be welcoming to adults.
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Excessive Interest In Particular Objects Or Activities
Babies readily shift their attention between people and objects creating opportunities to learn from social interaction.
Babies with autism may show excessive interest in particular objects or activities and can get stuck or overly focused on these.
This interest may be so intense that its difficult to shift their attention away from an object of interest to something else.
An intense interest can lead to skills that are advanced for their age, such as building with blocks, or learning the shapes of letters and numbers, and can be missed as a sign of autism.
If your child shows excessive interest in particular objects or activities, this may be an early sign of autism.
What To Do If Youre Worried
If your child is developmentally delayed, or if youve observed other red flags for autism, schedule an appointment with your pediatrician right away. In fact, its a good idea to have your child screened by a doctor even if he or she is hitting the developmental milestones on schedule. The American Academy of Pediatrics recommends that all children receive routine developmental screenings, as well as specific screenings for autism at 9, 18, and 30 months of age.
Schedule an autism screening. A number of specialized 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 childs behavior.
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Early Identification State Of The Art: Diagnosis And Screening Based On Behavior Alone
Currently, there is no standardized mechanism for the early identification of autism. Although parents of children who are later identified as having ASD typically become concerned about their childs speech and other behaviors between 15 and 18 months of age, they often delay discussing their concerns with their childs physicians for several months. Delays in social skills often are not noticed until the child is over 2 years of age. In one study, a delay of 20 to 60 months was found between parental suspicion and diagnosis by a medical professional. Furthermore, many parentsparticularly those who have not had prior childrenmay miss subtle signs of abnormal early development.
In order to promote and improve the early identification of autism, the AAP has recently published practice guidelines for the identification and evaluation of children with ASD. These guidelines recommend universal developmental surveillance during preventive, well-child visits by screening with standardized developmental tools during the 9-, 18-, and 24-month well-child visits, and ASD-specific screening at the 18- and/or 24-month well-child visits.
The most salient red fiags indicating risk are those related to social behavior
Major areas of weakness in social behavior for toddlers at risk for autism
A strong social drive during the early months in autism?
Levels of social engagement in infants at high risk for an ASDEarly brain overgrowth in autism
Communication: Early Signs Of Autism
In the first year of life, childrens social and communication development is an important area to watch for early signs of autism. Social and communication development includes things like learning to smile, make eye contact, and use gestures.
Social interaction and communicationIf young children are autistic, they might:
- not consistently use eye contact to get someones attention for example, they might not always look at you and then at a snack to show you they want it, or not look back towards you when they see something that excites them
- rarely point to or hold up objects to show you things for example, they might not point to a dog and look back at you to make sure youve seen it too, or they might drop a toy in your lap and walk away instead of holding it up and looking at you
- not consistently respond to their name being called
- not consistently use gestures on their own for example, they might not wave bye-bye or clap without being told to, or without copying someone else whos waving or clapping
- not consistently smile at you or other familiar people without you smiling at them first
- rarely copy other peoples actions, like combing their hair when you do it
- not sound like theyre having a conversation with you when they babble
- not understand simple, one-step instructions for example, Give me the block or Show me the dog.
Relationships and playIf young children are autistic, they might:
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Early Signs Of Autism Spectrum Disorder
Studies have shown that autism can be diagnosed as early as 14 months. It typically appears in the early ages of an individual.
This means that the infants first year is crucial in terms of the diagnosis of the disorder.
Many children with autism spectrum disorder show developmental differences. This can especially be seen in their social and language skills. There are certain developmental milestones babies hit while they are growing up.
Parents and caregivers should observe their childrens behaviors so as to be able to catch the disorder early on.
The 10 early signs of Autism Spectrum Disorder in children can be as follows:
- Little to no eye contact during infancy,
- No babbling,
- Not expressing emotions,
- Not seeming attached to parents.
Subtle differences caused by autism may appear before the childs first birthday. These differences will be visible in childrens interaction with their surroundings.
When 2-months old, babies generally begin to smile at people, coo, and are able to pay attention to faces. This may not be the case for children with autism spectrum disorder. By 6 months, if a baby
- doesnt smile,
- doesnt smile as big,
- is not showing any other warm, joyful, and engaging expressions
It may be a sign of autism spectrum disorder.
By 9 months, children with ASD:
- make limited or no eye contact with anyone
- dont share sounds,
- dont smile back-and-forth with parents.
Before their first birthday, babies on the autism spectrum,
Signs Of Autism In Babies
Some parents recognize autism signs when their child is 6-12 months old, depending on the symptoms and their severity. “Pay attention to whether or not the baby is reacting to social information and the environment. Within the first year of life, babies start to babble and use gestures like pointing,” says Dr. Frazier, adding that babies may also smile at their caregivers. “Baby noises should have some social function as well, and they should try communicating with parents.”
Babies with autism sometimes fail to communicate through sounds or gestures, and may not respond to social stimulation. Here are other early signs of autism.
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The Next Frontier: Biomarkers As Indicators Of Risk For Autism
One promising approach that has yet to make headway in the field of autism is the supplementation of behavioral criteria with biological markers . Biomarkers have vast potential for improving diagnostic efficiency, as their more proximal placement relative to risk genes may allow them to more realistically reflect the translational consequences of these genes in an easily quantifiable, reliable, and objective manner. The identification of a reliable biomarker for ASD could be used to supplement and validate existing clinical methods, or to construct a more efficient diagnostic tool altogether that overcomes the limitations of clinical behavioral methods. For example, an understanding of an infants or toddlers risk status based on a biomarker that is expressed at or even before the onset of symptoms might obviate the need to wait for behavioral criteria to be met before beginning treatment. This, in turn, would likely improve the prognosis of affected individuals.
Building Social And Communication Abilities
For children who receive early childhood ASD services, intervention focuses heavily on building and fostering socialrelational and communication abilities. An additional cornerstone of childhood ASD interventions includes developmental or habilitative therapies., These therapies not only aim to minimize any existing delays in communication and socialrelational abilities, but also work to enhance developmental skill progression across the broad developmental domains of communication, adaptive functioning , gross-and fine-motor skills, and cognitiveperceptual abilities . After developmental delays are minimized, efforts can be shifted to focus on optimizing developmental trajectories. Therapies begun early can also focus heavily on shaping development of desired daily routines, such as learning how to engage with the family at mealtime. For children with difficult behaviors, undesired behaviors are often easier to physically redirect in younger, smaller children. Thus, current best practice recommendations call for combined developmental and behavioral early intervention approaches for young children with suspected and confirmed ASD.,
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What Are The Signs Of Autism
The autism diagnosis age and intensity of autisms early signs vary widely. Some infants show hints in their first months. In others, behaviors become obvious as late as age 2 or 3.
Not all children with autism show all the signs. Many children who dont have autism show a few. Thats 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:
Stability Of Early Diagnosis
Diagnoses are made through clinical judgment in combination with comprehensive behavioral assessments using developmentally appropriate versions of the clinically standardized measures: the Autism Diagnostic InterviewRevised the ADOS , and the DSM-IV criteria . However, clinicians have questioned the applicability of the DSM-IV criteria to toddlers with ASD, as young children were underrepresented in the initial field trial of the instrument , and the utility of the restricted behaviors criteria have been questioned for younger age groups . The Autism Diagnostic Interview Revised may be less accurate for children with a mental age of less than 24 months and may underidentify ASD in higher functioning toddlers . A recent modification of the ADOS for younger children produced sensitivity and specificity scores of between 78% and 97% and 53% and 92%, respectively . Thus, it is important to recognize that the gold standards of ASD diagnosis may have limitations when used with infants and young toddlers. Increased knowledge of symptom manifestation in very young children has led to the development of new measures such as the AOSI and the ADOS-Toddler , which may begin to address these concerns. However, it is particularly critical for very young children that an experienced clinician couples judgment with standardized test scores in coming to a diagnostic decision, and diagnoses before the age of 3 years may be more appropriately treated as a provisional diagnosis.
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Little Pointing Or Gesturing
Babies usually learn to gesture before they learn to talk. In fact, gesturing is one of the earliest forms of communication. Autistic children generally point and gesture much less than children with nonautistic development. Less pointing can sometimes indicate the possibility of a language delay.
Another indicator of a developmental difference is when an infants gaze doesnt follow you when youre pointing at something. This skill is sometimes called joint attention. Joint attention is often decreased in autistic children.
My Child Has Signs Of Autismnow What
If your child has signs of autism, Dr. Frazier advises scheduling a visit to your pediatrician right away. You’ll discuss developmental concerns, and the doctor will evaluate your baby for autism. “We have evidence that suggests the quicker you can get a diagnosis, the earlier you can enroll in developmental and behavioral interventions,” says Dr. Frazier.
Early intervention is meant help your baby cope with autism symptoms and possibly even reverse them. As your child gets older, intervention might include speech therapy, occupational therapy, mental health counseling, and whatever else experts believe will help your child thrive. The ultimate goal is “making the symptoms more manageable and enhancing life as much as possible,” says Dr. Silverman.
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Social Interest And Attention
Retrospective studies reveal that some infants who go on to be diagnosed with ASD exhibit diminished social attention by 1 year, with poor eye contact, a lack of response to infant-directed speech, decreased reaction to attempts to engage the infant in play or interaction , and less orienting, smiling, and vocalizing to people . Other social behaviors that may be disrupted include social smiling, expressiveness, and affective responses to social touch . Similarly, in prospective studies researchers have noted lower levels of orientation to social stimuli such as faces or voices, poorer imitation, poor eye contact, lack of social interest, less social smiling, and reduced expression of positive emotion . These disruptions in social attention and social enjoyment likely diminish infants opportunity to learn about and from the people around them, and may indicate cause for concern when observed by parents or practitioners.
Reduced Emotion In Facial Expressions
Facial expressions are a nonverbal way to communicate thoughts and feelings.
Research on emotional expression in autistic infants is limited, but in studies involving school-age children, researchers have found that autistic children display less emotion through facial expressions than children with nonautistic development.
That doesnt necessarily mean autistic children are feeling less emotion, just that less of it shows on their faces when they do.
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Additional File : Appendix Table 1
Sample Socio-Economic Characteristics. Appendix Figure 1. Distribution of Clinical Signs & Symptoms by Levels of Severity. Appendix Table 2. The Effects of Various Variables on Age of Diagnosis. Appendix A. Regression Analyses. Appendix Table A1. Regressions of First Age of Diagnosis on Symptom Severity. Appendix Figure A1. The Effect of all Clinical Signs & Symptoms on Age of Diagnosis. Appendix B: Testing for potential recall-bias. Appendix Table B1. Child age at diagnosis, at time of survey, and time elapsed. Appendix Table B2. The effects of Time Elapsed on the Liklihood that a sign is recalled and the reported severity of the symptom.
Barriers To Early Diagnosis
Although some parents report a suspicion of ASD in the first 12 months,, many are told by healthcare providers to not worry about common features, such as slow language development or isolative behavior, that can be misinterpreted as shyness. However, clinicians are able to recognize the subtler signs of ASD and know that a reliable diagnosis can be made by age 2., In fact, ASD can be detected before age 2 using standard screening methods for ASD, such as the Modified Checklist for Autism in Toddlers , and later confirmed using gold standard diagnostic methods, such as the Autism Diagnostic Interview Revised and Autism Diagnostic Observational Schedule-2., Despite the availability of reliable methods for early diagnosis, the average age at which a child receives a diagnosis of ASD is currently between 4 and 5 years. Thus, there is a great need to minimize the time between when children can receive a diagnosis of ASD and when they are actually diagnosed. Indeed, reducing this gap is vital to improving long-term outcomes related to cognition, language, adaptive behavior, daily living skills, and social behavior.
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