KNOW YOUR CHILD- EARLY SIGNS OF AUTISM AND INTERVENTIONS

As a parent, you’re in the best position to spot the earliest warning signs of autism. If autism symptoms are observed during infancy, early intervention treatments can take full advantage of the young brain’s remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms of autism 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. 

The key is to educate yourself so you know what’s normal and what’s not. 

WHY IS EARLY DETECTION IMPORTANT?

Early detection is important because early diagnosis and early intervention programmes have been shown to improve functional outcomes and quality of life. Unfortunately, early diagnosis of ASD can be challenging. It is often diagnosed after the age of three years, despite caregivers raising concerns for possible ASD at 15–22 months. The presentation of ASD can differ greatly from one child to the next. Some are perceived by parents as ‘different’ during the first few months of life, while others present with delayed language development during the second year of life, and still others develop normally until 12–24 months but regress thereafter (‘autistic regression’). Locally, early diagnosis of ASD can be challenging when parents have poor awareness of the early symptoms of ASD or when they may not be the main caregivers; for instance, when working parents rely on the support of grandparents or domestic helpers. 

Developmental Red Flags 

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 

The autism spectrum is very wide. Some people might have very noticeable issues, others might not. The common thread is differences in social skills, communication, and behavior compared with people who aren’t on the spectrum. 

Social Skills 

A child with ASD has a hard time interacting with others. Problems with social skills are some of the most common signs. They might want to have close relationships but not know how. 

If your child is on the spectrum, they might show some social symptoms by the time they’re 8 to 10 months old. These may include any of the following: 

• They can’t respond to his name by their first birthday. 
• Playing, sharing, or talking with other people doesn’t interest them. 
• They prefer to be alone. 
• They avoid or reject physical contact. 
• They avoid eye contact. 
• When they’re upset, they don’t like to be comforted. 
• They don’t understand emotions — their own or others’. 
• They may not stretch out their arms to be picked up or guided with walking. 

Communication 

About 40% of kids with autism spectrum disorders don’t talk at all, and between 25% and 30% develop some language skills during infancy but then lose them later. Some children with ASD start talking later in life. 

Most have some problems with communication, including these: 

• Delayed speech and language skills 
• Flat, robotic speaking voice, or singsong voice 
• Echolalia (repeating the same phrase over and over) 
• Problems with pronouns (saying “you” instead of “I,” for example) 
• Not using or rarely using common gestures (pointing or waving), and not responding to them 
• Inability to stay on topic when talking or answering questions 
• Not recognizing sarcasm or joking 

Patterns of Behavior 

Children with ASD also act in ways that seem unusual or have interests that aren’t typical. Examples of this can include: 

• Repetitive behaviors like hand-flapping, rocking, jumping, or twirling 
• Constant moving (pacing) and “hyper” behavior 
• Fixations on certain activities or objects 
• Specific routines or rituals (and getting upset when a routine is changed, even slightly) 
• Extreme sensitivity to touch, light, and sound 
• Not taking part in “make-believe” play or imitating others’ behaviors 
• Fussy eating habits 
• Lack of coordination, clumsiness 
• Impulsiveness (acting without thinking) 
• Aggressive behavior, both with self and others 
• Short attention span 

Early intervention: what is it? 

Early intervention is specialized support for children with disability, Autism Spectrum Disorder (ASD) and other additional needs. Early intervention should happen as soon as possible after a child’s needs are identified. It might include therapies, education and other supports. 

You’ll also hear the terms early childhood intervention and early childhood early intervention. These refer to intervention for children and their families in the early years from birth until children start school. 

How does early intervention work? 

To start with, early intervention is usually universal. This means its intervention that anyone can get – for example, support and advice from paediatricians, child psychologists or other specialized therapists. 

Then as your child’s specific needs are identified or your child’s condition is diagnosed, interventions can be targeted to address your child’s and family’s specific needs. 

Early intervention often focuses on four key areas of children’s development: 

• physical development – that is, children’s bodies and brains 
• cognitive development – that is, children’s thinking and learning 
• behavioral development – that is, children’s behavior and how it’s affected by physical and cognitive development 
• Social and emotional development – that is, children’s ability to form relationships and cope with emotions. 

Different therapies used as part of early intervention address these developmental areas in different ways. For example: 

• Occupational therapy can help with fine motor skills, play and self-help skills like dressing and toileting. 
• Physiotherapy can help with motor skills like balance, sitting, crawling and walking. 
• Speech therapy can help with speech, language, eating and drinking skills like chewing, sucking and swallowing. 
• Psychological therapy can help with forming relationships, coping with emotions and learning behaviors and skills. 

Children often benefit from a combination of therapies – this is called a Multidisciplinary Approach. And children often need different therapies or therapy combinations at different stages of their development. 

References 

• Melinda Smith, M.A., Jeanne Segal, Ph.D., and Ted Hutman, Ph.D. Last updated: November 2019.autism-learning-disabilities/does-my-child-have-autism.htm 
• autismspeaks/what-are-symptoms-autism 
• webmd.com/brain/autism/symptoms-of-autism Reviewed by Renee A. Alli, MD 
• Australian Research Alliance for Children and Youth (ARACY) (2015). Better systems, better chances: A review of research and practice for prevention and early intervention. Canberra: ARACY. Retrieved 23 October 2019 from https://www.aracy.org.au/publications- resources/command/download_file/id/274/filename/Better-systems-better-chances.pdf. 

– Gurbani Kohli 

Clinical Psychologist