What is autism spectrum disorder (ASD)?
Autism Spectrum Disorder (ASD) or autism is a developmental disorder that affects a person’s social communication and interaction. Individuals with ASD also have restricted and repetitive behavior,interests and activities. These characteristics fall across a “spectrum” ranging from mild to severe. While one person may have symptoms that impair his or her ability to perform daily activities, another may have only mildly noticeable differences and have few, if any, functional impairments.
What are some of the first signs of autism?
Many parents first suspect a problem when their child does not reach developmental milestonessuch as speaking their first words or engaging in simple back-and-forth exchanges (waving “byebye”).A child may be able to complete a jigsaw puzzle with ease, but may not show interest in sharing his or her accomplishment with others.Some children may have no language delays and have sophisticated vocabularies, but have difficulty engaging in play or conversations with others.
How do I know if my child is developing typically?
While there are general trends in how children develop, all children grow and learn differently. Many factors affect a child’s progress toward developmental milestones, and it may be difficult for parents to determine whether their child is on track due to individual differences. If delays are present, early intervention can have a significant and lasting impact. Therefore, it is important to become familiar with child development and discuss any questions with your child’s healthcare providers.
How are ASDs first identified?
Pediatricians are often the first contact when parents become concerned about their child's development. During office visits, the physician may ask questions about the child’s development, and parents often share their concerns at that time.
The American Academy of Pediatrics (AAP) recommends that pediatricians screen for ASDs during well checks at 18 and 24 months and at any time a parent raises a concern. Pediatricians will ask the parent questions to assess their child's progress toward typical milestones. They may utilize one of the commonly used screening instruments, such as the Modified Checklist for Autism in Toddlers (M-CHAT) or the Childhood Autism Rating Scale (CARS). Careful consideration of parents' responses on the screening instrument allows the pediatrician to determine if there is cause for concern and referral. If the screening indicates a number of red flags, the pediatrician may recommend that the child participate in a multidisciplinary evaluation. Although the initial screening does not result in a diagnosis, it provides valuable information for the parents so they can begin treatment while waiting for an appointment with a full evaluation team.
What red flags in young children may indicate the presence of an ASD?
According to the Early Identification of Autism Spectrum Disorders: Guidelines for Healthcare Professionals in New Jersey from the Department of Health, Parents or caregivers should be alert to the following red signs:
- No babbling by 12 months
- No pointing or gesturing by 12 months
- No single words by 16 months
- No 2-word phrases by 24 months
- Loss of previously acquired skills, especially language
In addition to the concerns noted above, presence or absence of the following behaviors may be reason for a referral:
- Lack of joint attention (child does not draw other’s attention to objects in the environment)
- Child does not respond to his/her name
- Lack of pretend, imitative and functional play appropriate to developmental age
- Failure to develop peer relationships appropriate to developmental age
- Child does not imitate others’ behaviors
- Child is rigid in routines or has very difficult transitions
- Child engages in repetitive or stereotypical behavior
- Child has unusual responses to sensory stimuli
What do these concerns actually look like?
Difficulty with social interactions
Some individuals with autism do not spontaneously reach out to others to share information or feelings. Some may not seem to notice other people at all, while others strongly desire to interact with others but become overwhelmed in social situations due to deficits in social skills. With effective treatment, many people with autism learn social skills and come to enjoy spending time with others.
Difficulty with communication
Many individuals with autism have delays in or do not develop spoken language. Some may only communicate using single-word utterances or simple sentences. Other speech abnormalities include echolalia (immediate or delayed repeating of information), unconventional word use, and unusual tone, pitch and inflection. Others have complex vocabularies and can speak at length about topics that interest them, but they may have poor conversational skills. They may also have difficulty understanding nonverbal cues such as body language, facial expressions and eye contact.
Individuals with autism who do not develop functional speech can use augmentative means of communication, such as sign language, picture boards and technological devices. Autism-specific apps can help them communicate their needs and feelings and gain independence in their daily activities.
People with autism have restrictive, repetitive behavior, interests and activities. For example, a child with autism may play with only one toy or watch the same video repeatedly. They may engage in peculiar, sustained play activities such as spinning the wheels of a toy car instead of pretending to drive it, or dangling an object in front of their eyes for long periods of time. Others may focus intensely on a particular topic, such as dinosaurs or vacuum cleaners, to the exclusion of any other interests. Individuals with autism can be very reliant on specific routines and resistant to changes. Even a minor change in their routine or environment could be a great upset to a child or adult with autism.