When people hear the word “autism,” they probably don’t picture babies. After all, most aren’t diagnosed until they’re toddlers or even older. But ASD does exist in infants, and detecting it early on can make a difference for your child’s behavioral development and functioning in the future.
In this article, we’ll discuss what you can do as a parent if you think your infant might be on the spectrum.
What is early infantile autism?
Infantile autism isn’t distinct from “ordinary” autism—autistic kids and adults were also autistic babies; they just may not have been diagnosed until later.
Some people with ASD do reach typical milestones in language development and social skills at first before regressing around the age of 19 months, a phenomenon called regressive autism. Many people, though, show symptoms within their first year of life.
The term “early infantile autism” was coined by Leo Kanner, a psychiatrist at John Hopkins University, in 1943. His study of 11 children, who at the time would have been diagnosed as developmentally disabled or schizophrenic, was the first to suggest autism as a unique condition. He noted that, unlike schizophrenic patients, all of these patients displayed signs of being different from birth, leading him to believe there was a genetic factor. He characterized the disorder by antisocial behaviors, repetitive interests, and some language difficulties.
The work of Hans Asperger, published in 1944, also laid the groundwork for our modern understanding of autism spectrum disorders. He studied children with average, or even higher than average, intelligence and standard language use, but similar challenges with communication and social skills as Kanner’s subjects. Asperger’s research wouldn’t become well-known in the English-speaking world for a few more decades, but asperger syndrome is named for him.
The American Psychiatric Association used to list five types of autism: autism spectrum disorder (derived from Leo Kanner’s original early infantile autism), asperger syndrome, pervasive developmental disorder—not otherwise specified, childhood disintegrative disorder, and Rett Syndrome. In 2013, experts decided the diagnoses were too fluid, so they merged them into simply autism.
We still don’t know just what causes ASD, but potential factors include genetic makeup, having a sibling with ASD, being born to older parents, etc.
How can parents spot signs of autism in babies?
The majority of people with ASD aren’t diagnosed until they are three years old or older. Because social difficulties are such a large part of the disorder, it may seem hard to detect it in a child before he/she is old enough to be social with peers.
But there are characteristics that can appear when your child is an infant:
Lack of eye contact
- Most babies start to make eye contact with their parents around the age of two months. Babies with ASD may not do so, even while nursing
Lack of speech
- Two months is also the age when most infants gurgle and coo as their first attempts at language and verbal communication. By nine months, they will likely be testing out vowels and consonants and making sounds to express emotions. At one year, they can usually say “mama” and “dada” and try to repeat your words
- It can take much longer for autistic babies to reach these milestones in language development. If they do repeat words, it may be as a form of echolalia, rather than functioning language. Some will be nonverbal throughout their lives
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Lack of responsiveness
- Within a year, most babies will respond to their name and simple requests, understand the word “no,” engage in games like patty-cake, and react to cooing, hand-waving, and clapping. Meanwhile, autistic babies may not acknowledge their caregivers’ attempts at communication or interaction
Lack of attachment
- Studies have noted that babies with autism often don’t show much attachment or affection to their parents. According to Schriebman & Charlop (1989), they “may not mold to their parent’s body when held” or “remain stiff and rigid or ‘go limp’ when held.”
- They may also have little interest in being among siblings or other children
- Autistic infants can have a restricted interest in certain games or toys and engage in repetitive, ritualized play instead of imaginative play
Check out APM’s article Signs of Autism in Babies for more symptoms.
Treatment of infantile autism
Early intervention, if possible, can be crucial for a child’s future quality of life. A study by Ben-Itzchak & Zachor (2006) analyzed how 25 subjects, aged 20-32 months, progressed after a year of “intensive behavior intervention.” They had a range of intellectual, cognitive, language, and social challenges, with some functioning at higher levels than others. All the subjects made significant progress at least in language skills.
Of course, although babies can show signs of ASD, there’s a reason official conclusions usually aren’t made until they’re older. A 2019 study looked at 1,200 kids who had at least two evaluations during the study. Researchers measured the “diagnostic stability,” or the degree to which the diagnosis stuck, of patients diagnosed with ASD.
The diagnostic stability of diagnoses made around 12-13 months was 50%, 80% around 14 months, and 83% around 16 months. Clearly, the older a child is, the more certain doctors can be that he/she has ASD.
Treatment of infants who are (or are suspected of being) autistic depends on what each child struggles with. Some kids with ASD are proficient in speech and language, while others aren’t. Some may have behavioral problems, like aggression, while others don’t. Every child is unique, so every parent’s search for a solution is unique, too.
One of the most common approaches to the disorder is Applied Behavior Analysis (ABA) therapy, which rewards healthy behaviors and thought patterns. Your child may also need occupational therapy, speech therapy, or other behavioral interventions.
Even if a child with developmental difficulties doesn’t turn out to be autistic, there’s no harm in accessing treatment. Addressing cognitive delays of any kind early will hopefully improve his/her language and behavioral and social functioning later in life.
It’s normal to be worried and scared if your baby isn’t developing as you think he/she should. Whether ASD is the final diagnosis, he/she has a different disorder, or he/she is just a late bloomer, you should keep track of his/her behaviors, speech, social interactions, and milestones and take any concerns to your doctor.
If your son or daughter does have ASD, there is a range of resources for you to access—and a community of families ready to support you.
Ben-Itzchak, Esther, and Ditza A. Zachor. “The effects of intellectual functioning and autism severity on outcome of early behavioral intervention for children with autism.” Research in Developmental Disabilities, vol. 28, no. 3, 2007, pp. 287-303. PubMed, https://pubmed.ncbi.nlm.nih.gov/16730944/. Accessed 2021.
Brown, Maressa. “What parents need to know about how autism spectrum disorder is diagnosed.” Care.com, 21 May 2020, https://www.care.com/c/stories/6635/understanding-the-5-types-of-autism/. Accessed 1 June 2021.
Centers for Disease Control and Prevention. “CDC’s Developmental Milestones.” Centers for Disease Control and Prevention, 2021, https://www.cdc.gov/ncbddd/actearly/milestones/index.html. Accessed 25 May 2021.
Fischbach, Gerald D. “Leo Kanner’s 1943 paper on autism.” Spectrum News, 7 December 2007, https://www.spectrumnews.org/opinion/viewpoint/leo-kanners-1943-paper-on-autism/. Accessed 27 May 2021.
McCarthy, Claire. “How early can you — and should you — diagnose autism?” Harvard Health Publishing, 23 August 2019, https://www.health.harvard.edu/blog/how-early-can-you-and-should-you-diagnose-autism-2019082317653. Accessed 26 May 2021.
Schreibman, Laura, and Marjorie H. Charlop. “Infantile Autism.” Handbook of Child Psyhcopathology, Springer, 1989. SpringerLink, https://link.springer.com/chapter/10.1007/978-1-4757-1162-2_6#citeas. Accessed 2021.