Autism: Know The Warning Signs
Autism impacts one in every 88 children in the United States, and my son is that one. I’m Tara Cohen, and I’m the voice behind many of the Lauren’s Hope blog articles that (I hope!) you enjoy regularly. Last April, here on the Lauren’s Hope blog, I shared a little glimpse into life as a special-needs parent in honor of Autism Awareness Month. The year before, Lauren’s Hope did an awareness piece on my son, Will, before I joined the Lauren’s Hope team. This year, as the prevalence of autism grows ever more alarming than ever before, I’d like to share some early warning signs to help parents know what to look for in children under age two.
Although diagnoses prior to age three are now commonplace, when Will, now 8, was diagnosed just shy of his second birthday in 2007, it was almost unheard of. In fact, at the time of Will’s diagnosis, many professionals we spoke with weren’t even aware of diagnostic criteria for children under age four. Considering that children are often able to make their greatest gains before age five, early diagnosis is not only essential, it’s imperative for increasing the odds of truly helping your child.
Still, many parents don’t know what to look for, especially when they’re first-time parents with no older children around for comparison. There are, fortunately, a few very simple things to watch for:
Pointing: At your child’s 24-month checkup, the doctor will likely ask if your child points to things s/he wants. Almost unanimously, parents say yes, but many children (even some who do not have autism) do not actually point, but rather they reach and gesture with open hands toward objects they want. This is not the same as pointing, and it’s an important distinction to watch for between 12 and 18 months. Children at this age, when developing typically, will point to objects they want and the objects or actions they want the adults around them to notice. As well, when the adults around them point to things and speak (e.g. “Look at the bird!”), typical children will look in the direction the adult is pointing and looking. This is called Joint Attention, and it is usually lacking in children with autism.
Eye Contact: Children with autism often lack typical amounts of eye contact. Rather than looking in the eyes of the adults around them, they look elsewhere on the face, or they do not look at the adults at all. For example, most toddlers look to their parents when they’re confused or curious about how to respond in a given situation, but many children with autism do not. Additionally, typical toddlers look at toys with which they’re playing, then seek eye contact for reinforcement or engagement with their parent(s), then look back to the toys. This concept is similar to the Joint Attention mentioned above. It’s about social referencing and engagement: sharing an activity or interest with another person through gestures, body language, and eye gazing. Watch your baby and toddler (6-18 months) and pay attention to how often s/he really looks you in the eye and whether s/he does so for appropriate social reciprocity.
Lack of Pretend Play: Between ages 12 and 18 months, children typically begin engaging in imaginative play. There’s a misconception that children with autism do not play with toys but rather just line them up or bang them on hard surfaces. While some children with autism do these things, it’s important to note that at this young age, many children with autism play with toys, sometimes appropriately. What you’re really looking for is true imaginative play. This means watching your toddler as s/he plays with a toy truck. Does s/he flip it over and simply spin the tires, or does s/he make “vroom” noises while pretending to drive a bunch of animal toys to school? Does your child simply put plates and cups in the cabinets of a toy kitchen, or is s/he pretending to prepare or eat food? The difference is subtle but important.
Lack of Name Recognition or Response: Children with autism often do not respond appropriately to the adults around them. They will not turn when their names are called the way typical children do. Be aware that there’s a difference between a child turning at the sound of his own name and a child turning in response to a loud voice. Use normal tone and volume, and say your child’s name. Does s/he look up and make eye contact with you then, or only when you speak very loudly?
It’s important to be aware that there is no blood test for autism, and no single observation made from the list above constitutes a diagnosis. An autism diagnosis is something that takes time and repeated observation by autism and developmental specialists. Additionally, many children are simply “late bloomers” who may not hit developmental milestones right on time but will still develop along the typical path, even children who show some of the signs above. These children may have developmental delays, speech or communication disorders, or other disabilities for which they need extra assistance (i.e.: speech, occupational, behavioral, or physical therapy).
Please keep in mind that the bullet points above are warning signs, not diagnostic certainties. If you are concerned about your child’s development, consult your pediatrician immediately, and be specific about the signs you’ve noticed. Lastly, remember that the “wait and see” approach does no one any good, but a little speech therapy that turns out to be unnecessary never hurt anyone. It’s always better to be safe (and proactive!) than sorry.
Looking for more information? Read here about why every child with autism should wear medical ID jewelry.