Early Diagnosis of Autism
Recognizing the Signs in Infants and Toddlers
- Your twelve month old doesn’t turn around when you call his or her name, but appears to hear fine, in fact, she cringes in fear every time you turn on the vacuum cleaner.
- Your 18 month old hasn’t started speaking yet and never seems to look you in the eye.
- Your two-year old isn’t putting two words together and lately you notice that he’s been lining up his cars in a particular order, instead of pushing them around. If you accidentally move one, he bursts into a tantrum.
Each of these children exhibits early signs of autism.
If any of these scenarios sound like your child—don’t panic. Early development is often uneven. Some children are simply late talkers, some are more rigid than others, and many toddlers engage in “selective hearing,” particularly if they are engrossed in a favorite activity. Do seek the opinion of your pediatrician and request a referral for a psychologist or neurodevelopmental pediatrician for a more thorough assessment. Effective treatment is available and the sooner you get help, the sooner your child can begin to make gains.
Autism spectrum disorders (ASDs) are developmental disabilities that are characterized by problems with communication, social and play skills deficits, and behavioral issues. The disorder affects people across all racial, ethnic and economic groups. However, it is four to five times more likely to occur in boys than it does in girls. Contrary to popular perception, not all people with autism flap their arms, rock back and forth, resist eye contact, or avoid affectionate contact. Nor are they all geniuses with the ability to count cards and make a fortune playing blackjack. Like snowflakes, no two people with ASD are alike. Because autism is a spectrum disorder, each person is affected in different ways with symptoms that range from mild to severe.
Autism is increasingly prevalent all over the world. We don’t know why. Some hypothesize that more pediatricians are informed about the signs and symptoms of autism and are better able to diagnose it when they see it. Others believe that our environment is becoming increasingly toxic, and when an environmental trigger “turns on” a genetic predisposition, autism can result.
A recent 6-year longitudinal study from South Korea that found a shocking 2.6% of all South Korean school children have an autistic spectrum disorder (ASD). In the United States, the Centers for Disease Control report that 1 in 110 (or 1.1%) of all children have an autistic spectrum diagnosis. The difference in rates is likely attributed to the fact that every child aged 7-12 in the town of Ilsan, South Korea was screened for autism, whereas CDC data is based on looking at the numbers of children than have been diagnosed in several major cities. If the United States adopted the practice of screening all children for autism, it is possible that domestic rates would be higher.
The CDC reports that the average age at which children are diagnosed with ASD in America is around five years old. However, autism disorder can be detected by professionals, such as psychologists or neurodevelopmental pediatricians as early as18 months. Late diagnosis means lost time.
Early diagnosis is essential so that parents can seek early intervention as soon as possible. Typically, a town or city’s health department provides screening and if the child qualifies, he/she may be entitled to early intervention services at no cost to the family. For children with autism, behaviorally-based treatment or applied behavior analysis (ABA) in combination with speech therapy and other augmentative therapies such as occupational or physical therapy can make a dramatic difference in a child’s early development. Specially trained therapists work on breaking down complex skills into their basic component parts and teaching each part “discretely,” one step-at-a-time, until the child achieves mastery.
Although there are no medical tests available yet for the early detection and diagnosis of autism, we may not be far from this possibility. A small study at the King’s College Institute of Psychiatry in London has demonstrated that a brain scan has been proven to have a 90% success rate in detecting adult males with autistic spectrum disorder. For now, however, autism is diagnosed through extensive, semi-structured interviews with parents, caregivers, and teachers, close observation of children, and using diagnostic tools, such as the Autism Diagnostic Observation Scales (ADOS) to create opportunities for children to display behaviors associated with autism. When looking for someone to make a diagnosis, it is important to seek a psychologist, neurodevelopmental pediatrician or interdisciplinary team (which also may include speech therapist and possibly an occupational and/or physical therapist) who specializes in this area and has seen many children with many different presentations of the disorder. Often, subtler forms of autism, such as pervasive developmental disorder-not otherwise specified (PDD-NOS) or asperger syndrome may not be as easily detected or mistaken for other diagnoses.
Effective screening is the key to making sure a child suspected of having autism is identified as soon as possible. An NIH-funded study recently looked at the feasibility of a five-minute screen that identifies some of the subtle signs of autism in 12 month olds. Using the screen, caregivers completed a checklist, The Communication and Behavioral Scales Developmental Profile Infant-Toddler Checklist in their pediatrician’s waiting rooms. This brief questionnaire poses questions about the infant’s use of eye gaze, verbalizations, gestures, objects and developmentally-appropriate communication skills. Children who did not pass the screen were referred for further assessment and re-evaluated at six-month intervals until they turned three.
The number of children identified as having ASD using the Checklist, 32 out of 10,479, reflects current US prevalence rates. All of these children were referred for behavioral therapy at approximately 17 months, essentially four years younger than the national age of identification and referral. Pediatricians included in the study were so pleased with the screen, 100% of the 137 pediatricians who piloted the instrument continued to use it in their practice. The hope is that, one day soon, all children will be screened for early signs of autism at their 12 month check-up.
Until the screen comes to a pediatrician near you, please review the following early signs of autism in infants and toddlers.
- By 6 months: A lack of eye contact, broad smiles or other joyful expressions
- By 9 months: No “conversational” back and forth sharing of sounds, smiles, or facial
- By 12 months: A lack of response to name, no babbling, no communicative gestures
- By 18 months: No single words
- By 24 months: No two-word meaningful phrases
- Any regression or loss of speech or babbling or social skills at any age
If you know a child who displays any of these early signs of autism, please don’t hesitate to seek an evaluation through early intervention or a qualified psychologist or doctor. There is no cure for autism, but the sooner a child receives behavioral intervention, the more likely he or she is to make critical developmental gains.