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Signs of Autism

If you are concerned about your child's development, you are not alone.  As parent's we are worried constantly about our children.  Within the past year, we have heard more and more about autism.  Awareness is higher than ever.  Television, magazines, and newspapers are discussing signs to look for if a parent suspects autism.  With that in mind, it is important that you are accessing information that is reliable and accurate.  Outlined below is a step-by-step process to help families understand the signs of autism, screening and assessment, interventions and treatments, and connecting with other families. 

 

STEP 1:          Does your child demonstrate some of the symptoms of autism?

It is very important to remember that all children with autism are different.  However, all children with autism experience some of the same core challenges that are described below.  Some children can exhibit all of the symptoms, while other children might only demonstrate a few of the symptoms.  The earliest signs of autism are the absence of things that are typically seen in the first year of life and can be easy signs to miss.  For example, an infant who is later diagnosed with autism may not respond to a parent's smile or not respond as often as infants who do not have autism.  Later signs of autism are the presence of behaviors that are atypical and can include things such as rocking or spinning or unusual use of vision or gaze (see below).  These signs typically are not seen until a child is around 18-24 months or age or older. 

The following is taken from the American Academy of Pediatrics [Published online: 4/07 Source: Understanding Autism Spectrum Disorders (ASDs): An Introduction (Copyright © 2006 American Academy of Pediatrics)].

Social differences

  • Doesn't snuggle when picked up, but arches back instead
  • Doesn't keep eye contact or makes very little eye contact
  • Doesn't respond to parent's smile or other facial expressions
  • Doesn't look at objects or events parents are looking at or pointing to
  • Doesn't point to objects or events to get parents to look at them
  • Doesn't bring objects to show to parents just to share his interest
  • Doesn't often have appropriate facial expressions
  • Unable to perceive what others might be thinking or feeling by looking at their facial expressions
  • Doesn't show concern (empathy) for others
  • Unable to make friends

Communication differences

  • Doesn't say single words by 15 months or 2-word phrases by 24 months
  • Repeats exactly what others say without understanding its meaning (parroting or echolalia)
  • Doesn't respond to name being called, but does respond to other sounds (like a car horn or a cat's meow)
  • Refers to self as "you" and others as "I" (pronominal reversal)
  • Often doesn't seem to want to communicate
  • Doesn't start or can't continue a conversation
  • Doesn't use toys or other objects to represent people or real life in pretend play
  • May have a good rote memory, especially for numbers, songs, TV jingles, or a specific topic
  • Loses language milestones, usually between the ages of 15 to 24 months in a few children (regression)

Behavioral differences (stereotypic, repetitive, and restrictive patterns)

  • Rocks, spins, sways, twirls fingers, or flaps hands (stereotypic behavior)
  • Likes routines, order, and rituals
  • Obsessed with a few activities, doing them repeatedly during the day
  • Plays with parts of toys instead of the whole toy (for example, spinning the wheels of a toy truck)
  • May have splinter skills, such as the ability to read at an early age, but often without understanding what it means
  • Doesn't cry if in pain or seem to have any fear
  • May be very sensitive or not sensitive at all to smells, sounds, lights, textures, and touch
  • Unusual use of vision or gaze-looks at objects from unusual angles
  • May have unusual or intense but narrow interests

 

Regression in developmental milestones

  • About 25% of children will seem to have normal development until about 18 months, after which they will gradually or suddenly:
  • Stop talking (if they had begun to say a few words).
  • Stop waving goodbye.
  • Stop turning their heads when their names are called.
  • Withdraw into a shell and seem more distant and less interested in their surroundings.

 

STEP 2:          What do I do if my child demonstrates some of the signs of autism?

Your child exhibits some of the signs of autism, and you want to get your child checked.  Sometimes parents become frustrated because they have discussed their concern with their pediatrician, and their pediatrician told them to wait!  Do not let this slow you down; if you are truly concerned about your child, you can still seek out help! 

You need to decide if you would like to have your child screened or assessed for autism or possibly both.  Here are the pros and cons for both:

Screening

Screening is a process of identifying children who need more extensive evaluation and assessment.  Screening tools can focus on developmental and behavioral milestones, and can be completed by parents and professionals.  Providers are not necessarily required to have a particular educational degree to administer screening tools.  However, providers administering screening tools need to understand typical child development and the signs of autism (absence of expected or presence of unexpected skills and behaviors).  For example, if your child is currently receiving therapy services, the provider might screen your child for autism using the Checklist for Autism in Toddlers (CHAT) or the Modified Checklist for Autism in Toddlers (M-CHAT).  Or, if your child attends school, a teacher might screen your child for autism, if they are educated in autism.  The pros to screening include quick administration and reduced cost and resources.  A screen is easy to administer and the results are easy to interpret.  The negative to using screening tools for autism is that the results do not indicate whether or not the child has autism; it only rules in or rules out the possibility of autism.  When a screening tool demonstrates a high chance of autism, the child needs to get evaluated and assessed by a professional who can diagnose.  For some families, screening is an easier way to get started, for others moving forward with a diagnostic evaluation is better.  For children under age 3, SoonerStart can provide a screening for autism.  For children over 3, the local school district can provide screening and evaluation resources. 

Assessment

An assessment for autism needs to be performed by a licensed professional.  The goal of the assessment is to determine whether or not your child has autism and to help you identify strengths and weaknesses for planning your child's program.  In order to diagnosis autism, the professional needs to be either a licensed psychologist (Ph.D, Psy D) or a physician (M.D or O.D.).  Many times other professionals will also be on the team to assist in the diagnosing process (e.g. speech therapist, occupational therapist). 

A good assessment has the following components:

  • Input/interviews with parents and teachers (if applicable).
  • Observation of the child in various settings (e.g. classroom, home, free time, structured time).
  • Cognitive and achievement assessment.
  • Adaptive behavior assessment - this looks at how the child is adapting to daily activities (e.g. behavior, self-care).
  • Clinical judgment - professionals who are on the team need to have training in diagnosing autism in order to make good clinical judgment about your child.
  • Ideally more than one professional on the team (e.g. speech therapist, occupational therapist, social worker, physical therapist).
  • Overall, the assessment will look at your child's communication, social skills, and overall behavior. The team should use standardized tools to assist in diagnosing your child. Two common tools used to diagnosis autism are the Autism Diagnostic Observation Scales (ADOS) and Autism Diagnostic Interview- Revised (ADI-R).

As you can see, an assessment is much more time consuming and involved.  The pros to a good assessment are that you should have either a positive diagnosis for your child or rule out autism.  The negative to starting with a full assessment is that it can be costly, timely, and difficult for your child.  For a list of clinics in Oklahoma who perform assessments, visit our Provider data base.

 

STEP 3:          Learn about autism.

 

Start thinking about your goals for your child, resources you might access, and intervention(s) to help with the challenges you are observing in your child.  Even if have not yet received the diagnosis of autism, it is not too early to start intervention with your child.  Everything in the research on autism, states that the earlier the better!  See our pages on family supports, research and best practices and interventions and therapies for more information.

 

STEP 4:          Connect with other families.

 

This step is listed as last, but definitely not least!  We strongly recommend that you do this at anytime during this process!  Get feedback from other parents.  Visit the Oklahoma Family Center for Autism's resources page for family support groups and their message board page.  We highly suggest that you start talking with other parents in order to get their insight and help with resources.

For more information on signs and symptoms of autism, please visit:

http://www.aap.org/
http://www.firstsigns.org/
http://www.autismspeaks.org/