Autism-- Early Detection

Early Detection!
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 behaviors and quirks that a pediatrician,
in a quick fifteen-minute visit, might not have the chance to see. Your child’s pediatrician
can be a valuable partner, but don’t discount the importance of your own observations and
experience. The key is to educate yourself so you know what’s normal and what’s not.

 • Monitor your child’s development. Autism involves a variety of developmental delays, so
keeping a close eye on when—or if—your child is hitting the key 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 “normal.” But if your child is not meeting the milestones
for his or her 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 simply
“grow out” of their problems. In order 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. 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 disorders 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 he or she 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 very 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 normal behaviors—not the presence of abnormal 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 out to be picked up, or look at their mothers
when being fed.

Early Signs of Autism in babies and toddlers

•Doesn’t make eye contact (e.g. look at you when being fed).
•Doesn't smile when smiled at.
•Doesn't respond to his or her name or to the sound of a familiar voice.
•Doesn’t follow objects visually.
•Doesn't point or wave goodbye or use other gestures to communicate.
•Doesn’t follow the gesture when you point things out.
•Doesn’t make noises to get your attention.
•Doesn’t initiate or respond to cuddling.
•Doesn’t imitate your movements and facial expressions.
•Doesn’t reach out to be picked up.
•Doesn’t play with other people or share interest and enjoyment.
•Doesn’t ask for help or make other basic requests.

The following delays warrant an immediate evaluation by your child's pediatrician.
*By 6 months: No big smiles or other warm, joyful expressions.
• By 9 months: No back-and-forth sharing of sounds, smiles, or other facial expressions.
• By 12 months: Lack of response to name.
• By 12 months: No babbling or “baby talk.”
• By 12 months: No back-and-forth gestures, such as pointing, showing, reaching, or waving.
• By 16 months:  No spoken words.
• By 24 months: No meaningful two-word phrases that don’t involve imitating or repeating.

Signs and symptoms of autism 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 behavior.
Basic social interaction can be difficult for children with autism spectrum disorders. Many kids
on the autism spectrum seem to prefer to live in their own world, aloof and detached from others.
•Appears disinterested or unaware of other people or what’s going on around them.
•Doesn’t know how to connect with others, play, or make friends.
•Prefers not to be touched, held, or cuddled.
•Doesn’t play "pretend" games, engage in group games, imitate others, or use toys in creative ways.
•Has trouble understanding or talking about feelings.
•Doesn’t seem to hear when others talk to him or her.
•Doesn't share interests or achievements with others (drawings, toys).
Children with autism spectrum disorders have difficulty with speech and language. Often, they start talking late.
•Speaks in an abnormal tone of voice, or with an odd rhythm or pitch (e.g. ends every sentence as if asking a question).
•Repeats the same words or phrases over and over.
•Responds to a question by repeating it, rather than answering it.
•Refers to themselves in the third person.
•Uses language incorrectly (grammatical errors, wrong words).
•Has difficulty communicating needs or desires.
•Doesn’t understand simple directions, statements, or questions.
•Takes what is said too literally (misses undertones of humor, irony, and sarcasm).
Children with autism spectrum disorders have trouble picking up on subtle nonverbal cues and using body
language. This makes the "give-and-take" of social interaction very difficult.
•Avoids eye contact.
•Uses facial expressions that don't match what he or she is saying.
•Doesn’t pick up on other people’s facial expressions, tone of voice, and gestures.
•Makes very few gestures (such as pointing). May come across as cold or “robot-like.”
•Reacts unusually to sights, smells, textures, and sounds. May be especially sensitive to loud noises.
•Abnormal posture, clumsiness, or eccentric ways of moving (e.g. walking exclusively on tiptoe).
Children with autism spectrum disorders are often restricted, inflexible, and even obsessive in their behaviors,
activities, and interests.
•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 certain order.
•Preoccupation with a narrow topic of interest, often involving numbers or symbols (e.g. memorizing and reciting
facts about maps, train schedules, or sports statistics).
•Spends long periods of time arranging toys in specific ways, 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 over and over again, such as flapping hands, rocking, or twirling
(known as self-stimulatory behavior, or “stimming”). Some researchers and clinicians believe that these behaviors
may soothe children with autism more than stimulate them.

Common Self-stimulatory behaviors
•Hand flapping
•Rocking back and forth
•Spinning in a circle
•Finger flicking
•Head banging
•Staring at lights
•Moving fingers in front of the eyes
•Snapping fingers
 •Tapping ears
•Scratching
•Lining up toys
•Spinning objects
•Wheel spinning
•Watching moving objects
•Flicking light switches on and off
•Repeating words or noises
Prenatal factors that may contribute to autism:
Taking antidepressants during pregnancy, especially in the first 3 months 
• Nutritional deficiencies early in pregnancy, particularly not getting enough folic acid
• The age of the mother  (children born to older fathers also have a higher risk of autism)
• Complications at or shortly after birth,  including very low birth weight and neonatal anemia
• Maternal infections during pregnancy
• Exposure to chemical pollutants, such as metals and pesticides, while pregnant

Autism