Autism spectrum disorder (ASD/autism) is a developmental disability that can cause significant social, communication, and behavioral challenges. A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder. (CDC, 2017)
Red Flags of Autism
The following “red flags” may indicate that your baby or toddler is at risk for an autism spectrum disorder. If your child exhibits any of the following, please don’t delay in asking your pediatrician or family doctor for an evaluation:
- 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.
- At any age: Any loss of speech, babbling or social skills.
Characteristics of Autism
The signs/symptoms of autism listed below are illustrative, not exhaustive. As a spectrum disorder, individuals with autism may display a variety of signs and symptoms. The absence of one or more sign/symptom doesn’t preclude a diagnosis or autism, and the presence of a single or sign/symptom does not necessarily indicate the presence of an ASD.
Signs and symptoms of social difficulties in autism:
- 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).
Signs and symptoms of speech and language difficulties in autism:
- Speaks in an abnormal tone of voice, or with an odd rhythm or cadence.
- Repeats the same words or phrases over and over.
- Responds to a question by repeating it, rather than answering it. echolalia,).
- Uses idiosyncratic phrases.
- Refers to him/herself 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).
Signs and symptoms of nonverbal communication difficulties in autism:
- 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).
- Abnormal posture, clumsiness, or eccentric ways of moving (e.g. walking exclusively on tiptoe).
Signs and symptoms of restricted, repetitive patterns of behavior, interests, or activities in autism:
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, Insists on sameness, inflexible adherence to routines, or ritualized patterns (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
- Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
- Repeats the same actions or movements over and over again, such as flapping hands, rocking, or twirling (known as self-stimulatory behavior, or “stimming”).
What to do if you are worried
One of the most important things you can do as a parent or caregiver is to learn the early signs of autism and become familiar with the typical developmental milestones that your child should be reaching.
- 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 child’s behavior.
- See a developmental specialist. If your pediatrician detects possible signs of autism during the screening, your child should be referred to a specialist, like The Autism Clinic at ABC of NC, for a comprehensive diagnostic evaluation. Screening tools can’t be used to make a diagnosis, which is why further assessment is needed. A specialist, like a child psychologist or developmental pediatrician, can conduct a number of tests to determine whether or not your child has autism.
- Seek early intervention services. If you or your child’s physician have concerns about atypical development, ask for a referral to early intervention services. Children who demonstrate several early warning signs may have developmental delays, and will benefit from early intervention whether or not they meet the full criteria for an autism spectrum disorder. While every child develops differently, early intensive behavioral intervention with children with autism improves outcomes, often dramatically.
- Don’t take a wait and see approach. Take action if you’re concerned. Every child develops at a different pace and 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.You risk losing valuable time at an age where your child has the best chance for improvement.
- Trust your instincts. Ideally, your child’s doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays. 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. Any loss of speech, babbling, gestures, or social skills should be taken very seriously, as regression is a major indicator for autism.