The earliest signs of autism and other autistic spectrum disorders (ASDs)
ASD children can seem fairly normal in the first year of life. If the ASD child is your first, it may be very difficult to recognize a problem since you don’t really know what to expect. Even if this is not your first parenting experience, we are constantly told by pediatricians, educators, well meaning family members, and so-called experts that all kids develop in their own way and time. This is certainly true, but in retrospect, most parents of ASD kids can recall some early signs of a problem, such as these very telling traits:
- Not making eye contact when talking, talked to or called
- Don’t smile when they see familiar people
- Limited or no baby talk (babbling or pre-speech)
- Don’t point or understand pointing
- Failure to play infant games like peek-a-boo, patty-cake or waving bye-bye
- Fixation on certain toys, objects, movies
- Failure to learn and consistently use familiar words
- Loss of words
- Odd non-verbal vocalizations (squeals, squeaks, grunts, melodic utterances)
- Lack of interest in family members
- Don’t like to be hugged or cuddled
- Repetitive rocking and twirling
- Arm and hand flapping
- Walking on toes
- Looking sideways (glancing out of side of eye)
- Easily upset by changes to routine or changing activities
- Don’t turn towards sudden noises (but can hear)
Or these traits which are harder to interpret as specific to ASD:
- Sensitivity to certain textures or being touched
- Sensitivity to bright light, especially fluorescent lights
- Sensitivity to loud or unusual sound
- Very limited diet and refusal to even try certain types of food. Often this is based on texture more than flavor.
- Frequent severe abdominal pain
- Long periods of screaming with no recognizable cause
- Weak muscle tone and uncoordinated movement
- Insensitivity to pain
- Unusually strong ability to memorize
- Inability to sleep or frequent waking during the night / gives up napping at an early age
- Self-injurious behaviors like biting and head banging
In addition to these clues, many ASD children have repetitive and unexplained rashes, frequent ear infections, frequent bouts of diarrhea and/or constipation, and severe colic. Some ASD children are just the opposite – never sick.
The Checklist for Autism in Toddlers (CHAT)
The checklist for Autism in Toddlers (CHAT) is a set of diagnostic criteria that can be used to screen children at 18 months of age. This is a big improvement over the more traditional criteria because it can catch ASD earlier. It is designed to be administered by a physician but is easy enough that any parent capable of being objective can administer it. The first part consists of nine YES/NO questions:
- Do they like to be swung and bounced?
- Are they interested in other children?
- Do they climb?
- Do they play peek-a-boo or hide and seek?
- Do they pretend?
- Do they use their finger to point to something they want?
- Do they point to indicate interest or to have you look?
- Do they play properly with small toys?
- Do they ever bring toys over to show you?
The second part requires observation of the child then answering five questions:
- Does the child make eye contact?
- After getting the child’s attention, pointing across the room at some object and asking the child to look, did they look at the object or your finger?
- Can you get them to demonstrate pretend play?
- After getting the child’s attention and asking them to show you some unreachable object, do they point to the object?
- Can the child build a tower?
The test scores a severe risk of autism when the child fails (answer is NO) the bold questions (Part 1, questions 5,7 and Part 2, questions 2,3,4). There is score of mild risk if the child fails only the pointing tasks (Part 1, questions 6,7 and Part 2, questions 2,4). A child is at risk for other developmental disorders if they fail more than three questions. This test and has been given to more than 15,000 infants with some success in predicting ASD.
AAP indications for immediate evaluation
The American Association of Pediatrics (AAP) has published a set of red flags that indicate a child should have an immediate ASD evaluation. These are:
- No babbling, pointing or other gestures by 12 months
- No single words by 16 months
- No 2-word spontaneous phrases by 24 months
- Loss of language or social skills at any age
The Autism Treatment Evaluation Checklist (ATEC)
The Autism Treatment Evaluation Checklist (ATEC) was designed to assist parents, physicians and researchers to evaluate treatments for autism. The Autism Research Institute (ARI) offers a no-cost internet scoring procedure that calculates four subscale scores and a total score from the ATEC. The scores are weighted according to the responses and the corresponding subscale. The higher the subscale and total scores, the more impaired the subject (your child). You can get a copy of the ATEC here. If your child has a diagnosis of autism or an ASD, or if you suspect there is a problem you should fill out an ATEC form to record your ASD child’s starting or baseline score. Be sure to be very honest, you do them no favor by exaggerating their skills. Once it is filled out, you can go to the ARI website and fill in the information. They will score the information and send you a report.
A word of caution concerning pediatricians and the medical establishment
If you even suspect that your child has a problem, you should seek professional advice immediately. Children with autism or related disorders do not usually get better on their own and may get much worse. Treatments are available and are much more effective when started early.
Pediatricians are the doctors best placed to be on the front line of autism diagnosis and treatment. They usually see our children first and most frequently. Unfortunately, pediatricians and the medical establishment in general, have a very distorted and unhelpful understanding of these disorders. Commonly, pediatricians take a conservative approach to diagnosis, preferring a wait-and-see approach to aggressive action. ASD children do not have the luxury of time! If your child gets a referral for further tests and if they get a diagnosis, parents are likely to be told that the best they can hope for is management of symptoms with prescription drugs. This might sound reasonable, but it fails to acknowledge what is known about causes and effective treatments. This means that most parents are not told that there are ways to determine what is at the root of their child’s problems and that once these problems are addressed, children with autism or ASDs can get better!