These days, it seems like every family we know has been affected by autism. And it's true. It is an epidemic. According to the latest studies from the American Academy of Pediatrics and the Centers for Disease Control and Prevention, autism now affects an astounding 1 in 100 children (1 in 58 boys). These statistics can frighten parents-- raising red flags on an behaviors that may or may not seem normal.
Parents Ask expert Dr. Robert Sears shared the Warnings Signs of Autism - now he's taking it a step further and answering this very common question:
Q: How can I Tell if My Child is Autistic?
A: Know the Signs! For some toddlers, the signs of autism are obvious: No language, no eye contact, obsessive-compulsive behaviors, self-injurious behavior, extreme tantrums, etc. But these are the severe cases. Such kids are actually the exception. Autism more commonly begins with more subtle signs. By educating parents and doctors about how to detect the early signs, children can be diagnosed at a younger age and intervention can begin.
Here are signs you can watch for in a toddler, both obvious and more subtle, that suggest there may be a problem:
• Lack of eye contact – Babies should be quick and eager to engage a parent (and even a stranger) with focused and prolonged eye contact. And it should be spontaneous on the part of the child; a parent shouldn’t have to work to get their child to look them in the eye.
• Side glancing – Babies should look directly at people or objects. Frequently studying objects from the corner of the eyes may be a concern.
• Focus on spinning objects – Children with autism are obsessed with staring at spinning objects, such as fans or wheels.
• Lack of babbling – By seven months a baby should begin using consonant sounds, and by twelve months should be spouting off phrases of jibberish. A quiet one-year-old who is still only cooing and gooing is delayed.
• No words by eighteen months – While many late talkers won’t go on to have autism, a toddler who has not said that first “mama” or more by eighteen months warrants a full developmental evaluation.
• Solo play – Toddlers should crave and seek out play with parents and other kids. Those that prefer to play alone may have delayed social development.
• Parallel play – This refers to a toddler who likes to play alongside others, often mimicking them, but doesn’t actually play with the other kids.
• Obsession with certain toys – Toddlers should be interested in engaging with a wide range of toys and objects. Those who obsess with only one or two main toys (it is often trains) may have some delay.
• Plays inappropriately with toys – Toddlers should feed their dolls, animate their stuffed animals, zoom their cars around, and bounce or roll balls back and forth. Those that line up their cars, treat their dolls or animals as simple objects, or simply look at a balls may have a concern.
• Repetitive, obsessive actions – Repeatedly turning lights on and off, opening and closing doors and drawers, or arm flapping and toe-walking can be a concern.
• Sensory aversions – Toddlers who are overly-annoyed by wearing shoes and socks or by clothing tags, can’t stand having sticky hands or a messy face, who don’t like swinging or spinning, or who are freaked out by large crowds and noisy places might have some sensory problems that are associated with autism.
Some children with autism don’t display enough obvious symptoms early on. It’s important for doctors and parents to also look for the following signs in preschoolers:
• Out-of-context language – Children should engage in back-and-forth conversation that fits in the context of a situation. If a child frequently answers questions, or spontaneously blurts out whatever’s on his mind, in ways that don’t fit the conversation, this may be a concern.
• Unusually advanced language skills – If a child is able to say the ABCs, recite nursery rhymes, list numerous famous composers, or talk incessantly about one or two primary topics in a manner that far exceeds his peers, but won’t converse about more simple and general topics, this may be a concern. It’s hard to imagine that such a brilliant child may have autism, but it’s possible.
• Answering a question with a question – If you ask a child, “What is your favorite color?” and the child answers, “What is your favorite color . . . green,” that may be a concern.
• Missing social cues – A child may understand language, but if he doesn’t pick up on sarcasm, humor, teasing, or lying, this is a concern.
• Unaware of personal space – A child with autism may hug total strangers and stand very close to other children in an unusual way.
• OCD tendencies – A child with autism may display some obsessive-compulsive behaviors, such as demanding all doors remain closed (or open), keeping food items separated on a plate, arranging toys or objects in lines, or wearing only certain clothes.
Detect a Problem Early
Pediatricians (myself included) used to think that it didn’t matter what age a child’s autism was diagnosed. Since there wasn’t much we could do about it, it didn’t matter if it was detected at age 1, 2, 3 or 10. We now know that the complete opposite is true. The earlier a problem is detected and the earlier intervention is started, the better the chance of recovery.
The “wait and see” approach is probably the worst thing a doctor or parent can do. Most pediatricians are probably guilty of offering this advice in the past. If a two-year-old wasn’t talking, we just blew it off with reassuring statements like “boys just talk late” or “don’t worry, he’ll pick it up soon.” If a child’s development was a bit behind, we’d tell the parents to spend more time stimulating their toddler and “we’ll see how he’s doing next year.” Now that we know how critical early treatment is, pediatricians and parents should act right away.
There are two keys to early detection: Parental awareness and formal pediatrician screening tests. Screening tests have been developed for pediatricians to perform at every child’s eighteen-month and two-year check ups. These tests are designed to detect at-risk children so that further developmental testing can be done for those who need it. There are also some screening tests for older kids who may have some delays in their social and language skills that could be missed on earlier screens.
The most popular autism screening test is called a CHAT (Checklist for Autism in Toddlers). The first part of the CHAT comprises nine developmental questions that are answered by the parent to make sure a toddler is meeting all the usual milestones. These include enjoying swinging or bouncing, showing interest in other kids, climbing, playing peek-a-boo, engaging in pretend play, pointing with the index finger, playing correctly with toys, and bringing objects to show the parent. The second part of the test involves the pediatrician’s observations, in which the doctor will make sure the child makes sustained eye contact, shows interest in something when the doctor points, plays appropriately with a toy cup or doll, points at something that the doctors asks about, and stack some blocks.
There are several other types of screening tests your doctor can choose from, but it is important that he or she performs some type of formal autism screening test. It isn’t enough to simply ask a mom if she thinks there are any developmental problems. Autism can begin with very subtle signs, and a first-time parent may not notice things that formal screening test will pick up.
I’ll be honest. As a pediatrician it’s not always easy to spot a toddler with autism early on. A doctor’s office doesn’t always bring out the best in a toddler’s behavior, and there isn’t always enough time to do a thorough developmental check. We have to partly rely on a parent’s own skills of observation. Pediatric care is a partnership between the parents and the doctor, and by working together we can better detect toddlers with early signs of a problem.