Ms. Renuka Desai, Occupational Therapist with Team Autism Connect Association
Little Om is a healthy one year old, but his parents are very anxious. He is unable to perform many activities that other kids in their family did at his age in terms of physical development as well as mimicking expressions and gestures. This hindered development, deeply concerned them. As new and enthusiastic parents, they tried their best to engage him with toys, games and songs, but to no avail. Nothing they did was working to spark his interest, or to get a reciprocal response through a laugh or even a faint smile. In fact, he would rarely make eye contact. Although his other investigations were normal, he couldn’t babble or respond to his name. Also, his pattern of toe walking and lining up toys worried them a lot. It was evident that little Om needed help and so did his parents. They were befuddled about his abnormal response in their normal life and in an attempt to rectify things, left no stone unturned. They reached out to a pediatrician with the hope of an early intervention and were told that their child has autism.
Parents often approach pediatricians with these common problems. These problems have complex explanations since there may be a multitude of variations in how and when the symptoms of autism begin to manifest.
As parents, it is essential to educate yourself regarding your child’s normal physical development along with normal expectations of cognitive, social and emotional milestones for children. (Create a hyperlink : from main content: understanding autism(Signs & symptoms of autism: cognitive and emotional chart) Although your pediatrician’s opinion is vital, it is always essential to also consider your own observations and experience. Bearing this in mind, we have elaborated on the key aspects of autism in this post to help you and your child throughout your journey of autism.
Early Indicators of autism:
1.Difficulty in non verbal communication:
- Avoids eye contact
- Does not respond to his/her name, or to the sound of a familiar voice
- Does not point or wave goodbye, or use other gestures of communication like big smiles or warm and joyful expressions.
- Has trouble in picking up on subtle nonverbal cues and using body language.
- Uses facial expressions that don’t match what he or she is saying.
- No back and forth sharing of sounds, smiles, or other facial expressions.
- Has an unusual reaction to sights, smells, textures and sounds. May be specifically sensitive to loud sounds.
- Finds it difficult to play with other kids of the same age and understand enjoyment.
2) Difficulty in speech and language areas:
- Delayed development of speech
- Echolalia, repetition of words or phrases
- Does not answer questions, but repeats the question monotonously without understanding it
- No meaningful two phrases words by age two
- Incorrect use of language (jumbling of words)
- Difficulty in communicating needs or desires
- Does not understand simple directions, statements or questions
- Does not understand tonal variations in speech and expression of emotional words
3) Difficulty in play behaviour and motor performances:
- Often restricted, inflexible and even obsessive in their behaviour patterns, activities and interests.
- Follows a rigid routine and has difficulty adapting to any changes in schedule or environment (For example, any change in the route he/she takes to the park)
- Likes the spinning of car wheels or any objects repeatedly without playing with it appropriately, or spends long periods watching moving objects like a ceiling fan.
- Unusual attachments to objects like straws, erasers, threads and wires
- Lining up of toys or collecting them in a corner rather than understanding the real purpose.
- Repetitive motor movements like flapping hands, clapping, rocking, head banging turning round and round (stimming behavior)
- Restricted interests in play like memorizing dates or maps, rather than exploring new play and shows high discomfort in learning new things.
4) Difficulties in social behavior:
- Uninterested in or unaware of other people’s presence or what is going on around them
- Difficulty in initiating a conversation or play and unable to connect with others
- Sensitive to touch (dislikes being touched)
- Does not play “pretend” games, engage in group games, imitate others or use toys in creative ways
- Has trouble in understanding feelings or talking about them and greeting people with eye contact
- Pays more attention to objects rather than people in a group
- Prefers to stay aloof, sits with his/her back turned (does not like facing the crowd)
- Does not seem to hear when other talk to him/her
- Uninterested in sharing or understanding other achievements (drawings, toys)
- Does not understand about waiting for his/her turn during play
A closer look at diagnostic screening for autism and developmental delays:
The Communication and Symbolic Behavior Scales Developmental Profile – Infant/Toddler checklist or simply CSBS DP Infant/Toddler checklist is usually the first step in routine screening. This test is well established and is available online. It is in the form of a simple questionnaire and takes just about five minutes to complete. This checklist enables you to take an early look at a collection of 7 key predictors of language delays that may occur later. However, it is important to bear in mind that this is not an autism-specific screen but a screen to catch autism and other developmental delays.
The following are a few questions from the checklist:
- Do you know when your child is happy and when your child is upset?
- Does your child do things just to get you to laugh?
- Does your child string sounds together, such as uh oh, mamma, gaga, bye-bye?
- When you call your child’s name, does he/she respond by looking or turning toward you?
- Does your child wave to greet people?
- Does your child smile or laugh while looking at you?
For years, autism has been an incurable disorder. The first question a parent asks after his/her has been diagnosed with autism is “How did my child get autism? Did it come from one of us?” and the answer has always been “We don’t know” or “It’s complicated”. This has given rise to a lot of fear and apprehensions not only in the minds of parents, but also among people around. As more and more people become aware about autism, perceptions are slowly changing for the better. People are now beginning to realize that although autism may be incurable, it can be managed with the right approach and mindset. Hence, it is always important to educate yourself, get timely treatment and open up about the problems you are facing.
Bearing this in mind, the following are some take-away points to help you guide your child:
- Be Vigilant about your child’s normal development in both physical and mental aspects. The earliest signs of autism involve the absence of normal behavior patterns as opposed to the presence of abnormal ones, making them difficult to spot. Most delays in development associated with autism including social and linguistic delays are usually identified at 18 months, if not earlier. Any kind of regression should be considered as a serious warning sign.
- Time is of the essence! Whether a developmental delay is caused by autism or some other factor, these kids experience difficulty in dealing with day to day life and need targeted treatment by a specialist to help them “grow out” of their problems. This treatment is targeted at developing both the child’s physical and mental functioning. If these delays are identified in infancy, it is more likely that treatment interventions can rectify problems due to the young brain’s increased ability of neuroplasticity*. Hence, it is important to note that time is always of the essence when dealing with developmental delays of any kind.
- Never leave any queries unanswered! Along with seeking an early intervention, it is also important to share your experiences with your child’s doctor. You should always report any abnormality you observe in your child’s behavior. It is essential to not panic but to be persistent in your observations and go for second referrals and opinions till your intuitive feelings are at ease.
*Neuroplasticity, also called neural or brain plasticity is defined as the ability of the brain to reorganize itself by forming new neural connections throughout life. This allows nerve cells (neurons) in the brain to compensate for damage, injury and disease and also to adjust their activities in response to new situations or to changes in their environment.