The early years of a child’s life usually is a non-stop celebration of “firsts” – first crawl, first steps, first words…first friends. However, what if your child isn’t reaching these milestones?
Every child is different, and meeting milestones at different times. So when should parents start wondering if something else is going on? You may observe early signs of autism, yet your child may not receive a diagnosis until they are two years old or older.
What is Autism?
Autism is a spectrum of a closely related development disorder characterized by difficulties in communication and social interaction. Autism spectrum disorder develops in infancy and early childhood, causing problems in many critical developmental milestones. These signs often develop gradually, although some children with autism reach their developmental milestones at a reasonable pace before worsening. While some people can be high-functioning, there are 60% who have below-average intellectual abilities. Also, one-third of people with autism are non-verbal.
Children with autism struggle to establish and maintain relationships. They do not comprehend the non-verbal aspect of communication, such as facial expressions, hand gestures, eye contact, and physical gestures. They may appear distant and aloof. They may withdraw into repetitive play and avoid social interaction. Their behavior is an attempt to communicate their feelings or to cope with the situation. By sticking to a rigid routine or repetitive behavior, they reduce uncertainty and maintain the predictability of their environment. Behavior problems may occur as a result of their heightened sensitivity to a sound or something they may have seen or felt.
Children and adults with autism experience a variety of symptoms, and no two cases are precisely the same.
Causes of Autism – a spotlight on environmental factors
Until recently, most scientists believe that autism is caused primarily by genetic factors.
Recent research indicates that environmental factors may also be important in the development of autism(5). In other words, babies may be born with a genetic vulnerability to autism that is then triggered by an external factor, either while in the womb or after birth.
In this context, the environment refers to anything in the womb (prenatal environment) or pollution in the atmosphere (external environment)
Prenatal factors that may contribute to autism
- Taking antidepressants during pregnancy, especially during the first trimester
- Nutritional deficiencies early in the pregnancy, mainly not getting enough folic acid
- The age of the mother and father
- Complications at or shortly after birth, including meager birth weight and neonatal anemia
- Maternal infections during pregnancy, such as rubella
- Exposure to chemical toxins, such as alcohol and valproic acid, while pregnant.
As parents, how do you spot the warning signs?
It’s heart-breaking to believe that your precious bundle of joy might have autism. However, catching it early – ideally by the age of eighteen months old – makes a huge difference. As parents, you are in the best position to spot the early warning signs of autism. The earlier your child receives a proper diagnosis, the sooner intervention can begin.
Monitor your child’s development. Autism involves a delay in a myriad of developmental milestones, so keeping a close eye on whether or not your child is hitting the critical cognitive, social, and emotional milestones promptly. While developmental delays don’t automatically mean autism, they may indicate a heightened risk.
Take action if you’re concerned. Don’t panic if your child is a little slow to talk or walk because every child develops at a different pace. However, if you suspect that your child is not meeting milestones due to autism, share your concerns with your child’s pediatrician immediately. Continuously monitor your child’s development and take action if you’re concerned. Don’t wait.
Don’t accept a wait-and-see approach. Many concerned parents are told, “Wait and see” or “Don’t worry.” However, the worst thing you can do is wait. You might lose valuable time at an age where your child has the optimal chance for recovery. Furthermore, autism or some other factors cause the delay, developmentally delayed kids are unlikely to “grow out of” their problems. Trust your instincts if it’s telling you something is wrong. Be persistent. Schedule a follow-up appointment with the doctor, or seek a second opinion.
Signs of autism in babies and toddlers
Between 6 to 12 months old
If autism is caught in infancy, the chances of recovery are best due to the remarkable plasticity of a young brain. It appears feasible to identify and enroll symptomatic infants in a parent-implemented intervention before 12 months old (2).
The first signs of autism are the absence of healthy behaviors – not the presence of abnormal ones – so they can be difficult to spot. Sometimes, the earliest symptoms are even misinterpreted as signs of a “quiet or undemanding baby.” However, you can catch the early warning signs if you know what to look for.
At this age, picking up on symptoms involves paying attention to whether your child is meeting developmental milestones. Specific behavioral signs as young as six months can predict whether a child will develop autism.
Watch out for the following signs.
Your baby DOESN’T like to:
- Show interest in faces
- Make eye contact (1)
- Respond to his/her name
- Cuddle or touch
- Show interest in social games, such as peekaboo
- Gesture, like reaching for you when she wants to be held
- Engage with their caregiver
Between 12 to 24 months old
Symptoms of autism often develop between this age period.
Here are some symptoms to watch out for:
- Doesn’t gesture (g., wave goodbye or point to things he/she wants)
- Loses verbal or social skills (g., used to babble or speak a few words, or show interest in people, but now doesn’t)
- Doesn’t walk on his/her toes
Two years old and up
Many children with autism remain undiagnosed until they reach two years old and beyond, probably because they’ve begun preschool and social interactions are noticeably strained. At this age, the red flags for autism become more diverse. The warning signs and symptoms typically revolve around verbal and non-verbal communication, relating to others, and thinking and behaving flexibly.
Signs of social difficulties
Essential social interaction can be awkward for children with autism. Many kids on the autism spectrum seem isolated from their peers. Some people might wrongly interpret an autistic child’s behavior as merely “rude behavior.”
Some examples include:
- Unable to recognize social cues and talk during inappropriate times
- Appears unaware or disinterested with their social environment
- Does not like physical contact
- Doesn’t know how to connect with others, make friends, or play
- Unable to understand or express feelings
- Doesn’t play social games or imitate others
Autistic toddlers may express frustration by throwing tantrums. It is, however, important to remember that this symptom is not usually a power struggle as it might be for a healthy toddler. Instead, it’s an expression of real frustration, pain, or fear that the child is attempting to communicate.
Signs of verbal difficulties
- Start talking late
- Speaks in an abnormal tone of voice, haltingly, or with an odd pitch or rhythm
- Repeats the same phrases over and over, often without communicative intent
- Responds to a question by repeating it, instead of answering it
- Misuses language (grammatical errors, wrong words) or refers to him/herself in the third person
- Has difficulty communicating needs or desires
- Doesn’t understand simple directions, statements, or questions
Signs of non-verbal communication difficulties
- Avoids eye contact
- Doesn’t pick up subtle nonverbal cues such as other people’s facial expressions, tone of voice, and gestures
- May come across as cold or “robot-like.”
Signs of inflexibility
- Follows a rigid routine
- Unable to adapt to a new environment
- Unusual attachments to strange objects
- Interested only in a narrow topic, often involving symbols or numbers
- Spend long hours watching move objects such as ceiling fan, or focusing on spinning the wheels of a toy car
- Repeats the same actions
Regression is a severe warning sign
Some children with autism may have a healthy development before regressing, usually between 12 and 24 months old. For instance, a child may stop playing peek-a-boo or stop speaking entirely.
Any loss of social skills or speech should be taken very seriously, as regression is a major red flag for autism.
Are you worried? How to get a diagnosis?
If you notice signs of developmental delay or other red flags in your child, schedule an appointment with a pediatrician. Send your child for screening even if he or she is hitting the developmental milestones on schedule. All children should be tested at nine months, 18 months, 2-year, and three years old.
Autism is often treated with a team approach that would involve psychologists, pediatric neurologists, developmental pediatrician, and psychiatrists.
An autism diagnosis can be accurately given at the age of 18 months. The earlier an infant is diagnosed, the sooner interventions can begin. Many children with autism, however, do not receive an official diagnosis until they reach the age of two years old. It is never too late to be diagnosed and start identifying resources to give your child as normal a life as possible.
Establish a plan with a pediatrician as soon as possible to make sure your child reaps the benefits of early intervention therapy. When autism is caught early, treatment can take full advantage of the infant’s remarkable brain plasticity, or ability to adapt and change.
There isn’t a one-size-fits-all approach because every child is different. Your pediatrician might need to try a few therapies to find an effective combination.
Types of treatment include:
- Social skills training. Your child will learn how to interact with others and express themselves more appropriately by modeling after typical behavior. The therapy may either be in groups or one-on-one sessions.
- Speech-language therapy helps improve your child’s verbal communication skills. For example, he will learn how to maintain a two-way conversation and understand social cues like eye contact and hand gestures.
- Cognitive behavioral therapy (CBT) helps your child change his way of thinking, so he can better control his repetitive behaviors and emotion. He’ll be able to manage situations like obsessions, meltdowns, and outbursts.
- Parent education and training. You’ll learn how to help your child work on social skills at home. Some families also see a counselor help them deal with the challenges of raising a child with autism.