Early signs of autism spectrum disorder (ASD) can be detected in babies, infants and toddlers, yet many children with autism do not receive a diagnosis until the ages of two or three. It’s not uncommon for babies to go undiagnosed. Signs of autism in infants can go undetected until later on in life.
The early signs of autism
There are many benefits to receiving a diagnosis before reaching preschool age. According to the Center for Disease Control (CDC), an autism diagnosis can be appropriately given at 18 months of age or sooner. Doctors screen for autism spectrum disorders at the nine-month, 18 month, 2-year, and 3-year wellness checkups. The earlier an infant gets an autism diagnosis; the sooner interventions can begin. Parents and caregivers can also identify the resources they need for treatment.
When can my child be diagnosed with autism?
Many children with autism do not receive an official diagnosis until they reach the age of two or three. It is often after the child has started school. This is when the child’s challenges in social skills become obvious. It is never too late to get a diagnosis and begin identifying resources to help make life with autism easier.
The earlier a child gets a diagnosis (especially in his/her formative years of development), the sooner the child can start therapy or treatment.
What are the early signs of autism in babies?
Every infant, child, and adult with autism will display unique symptoms. But there are several key traits that may point to autism. Autistic babies will not engage with their caretaker the same way neurotypical infants do. A baby with autism might not respond to cooing. He/She might also ignore movements such as waving and clapping.
A mother might notice her baby does not make eye contact while nursing. Autistic babies might have difficulty smiling or giggling. Additionally, autistic babies may be fussier and harder to console than their neurotypical peers.
Early signs of impaired social interaction may appear at six to nine months when neurotypical babies will start to imitate and respond to the people around them. Babies with autism will often not smile back or laugh when playing a silly game, and some may stare blankly and appear oblivious to the game. Others might even show distress with the sound of laughing. Oddly, an upset or loud voice might not startle nor mean anything to them.
Other developmental milestones they might not meet include responding to their name. They might also not babble at six months, which is usually when neurotypical babies start doing so. By 18 months, most babies engage in imaginative play. Infants with autism, however, will likely show no interest or become flustered.
Autism in toddlers
Toddlers with autism generally exhibit a progression of the symptoms expressed during infancy. Babies who did not make eye contact or a connection with caregivers carry these symptoms into toddlerhood. Autistic toddlers may express frustration via tantrums or outbursts.
It is important to remember this symptom of autism is not a power struggle as it might be for a neurotypical toddler. Rather, it is an expression of frustration, fear, or pain that the toddler is attempting to communicate. Establishing a plan with your toddler’s pediatrician to ensure he/she is granted access to resources as soon as possible is crucial in making sure your child reaps the benefits of early intervention therapies. Autism presents itself differently in toddler boys versus toddler girls. As a result, boys will often receive a more accurate diagnosis quicker than girls.
Autism symptoms in toddler boys
Diagnosing autism in toddler boys is markedly more common, and often easier than it is for their female counterparts. Boys aged two to four often begin to show symptoms associated with autism such as poor social skills, restricted interests, and sensory issues. Symptoms become obvious as they begin to meet other kids in school or daycare.
Toddler boys may also have pronounced difficulty connecting with their caretakers. Symptoms noticed as a baby, such as poor eye contact and a lack of engagement in play, may evolve into aggressive or apathetic relationships with caregivers. Additionally, sensory dysregulation is often harder for a toddler to manage as they receive intense stimuli that neurotypical children enjoy. Examples include birthday parties or group outings. Toddler boys generally have more access to resources and care than their under or misdiagnosed female peers. It is important to take advantage of these resources as soon as possible.
Signs of autism in girls and how they differ from boys with ASD
According to child behavior specialists at the Cleveland Clinic located in Ohio, only one in three children diagnosed with autism is female. Only one girl to every nine boys is diagnosed with high functioning autism or Asperger’s syndrome. Doctors are beginning to realize, however, that instances of autism in females are not necessarily less common. They are misdiagnosed as social communication disorders or developmental disorders.
A study of 300 girls by the Cleveland Clinic suggests autistic females are less likely to exhibit “classically male” symptoms. These include restricted interests, difficulties in social situations, episodes of intense aggravation, and self-harm.
These girls are often labeled as having developmental delays, but without the diagnosis of autism, their access to resources and care become limited. The Cleveland Clinic recommends being proactive and seeing your pediatrician if you notice signs your daughter is autistic, especially if she is in between regular check-ups.
What are the signs of autism in children?
The National Institute of Neurological Disorders and Stroke (NINDS) cites four major “classic” symptoms which are often used by pediatricians to diagnose children with autism:
- poor communication skills
- restricted interests
- stimming and repetitive behaviors
- limited to no verbal skills
Children diagnosed with autism as a toddler may already be working with a care team to manage their symptoms, but school-aged children can begin similar therapies at any time. Children with limited communication skills can learn to express themselves through writing and drawing.
Psychiatrists, psychologists, and occupational therapists can help autistic children learn how to better manage their challenges, validate their experiences, and help manage self-injurious behaviors.
When to see your pediatrician
During checkups, your child’s pediatrician will assess for developmental progress. In between appointments, however, you may notice your child is not developing similarly to his/her peers. He/She may not engage with you the same way other babies engage with their parents, or he/she may exhibit other symptoms listed above.
If you feel something is amiss, consult your child’s pediatrician to run a series of diagnostic exams. These exams are non-invasive and will often include a behavioral and developmental assessment. You might also be given a questionnaire for you and other caregivers in your child’s life.
What to bring to your appointment
Some parents find it helpful to keep a list of symptoms they suspect are likely to be autism. You can keep track of the frequency of instances each behavior occurs for reference. This kind of documentation will give your child’s pediatrician a better idea of how long and how often your child’s symptoms appear.
Most infants with autism will develop skills late—or might even regress in their social skills and sensory processing.
Getting a second opinion
If your doctor is unsure if a diagnosis of autism is appropriate for your infant, the CDC recommends seeking a second opinion. The earliest interventions can serve as building blocks for your child’s future therapies.
They also suggest acting early as interventions can change your child’s developmental path and improve outcomes in school and relationships. The CDC cites that in the first three years of a child’s life his/her behaviors are most malleable and that children are more likely to change undesirable habits and adopt positive ones most willingly during these years.
They suggest trying several interventions until you find one (and a therapist) your child responds to best.
What are the early interventions for ASD?
Your pediatrician can help you coordinate programs and strategies that will work best for your child. He/She can also act as the head of your child’s treatment team. He/She may suggest incorporating a psychologist, psychiatrist, occupational therapist, recreational therapist, or holistic approaches such as yoga.
The following are popular interventions and therapies used with an autism diagnosis:
Early Start Denver Model
Interventions for babies with autism usually take the form of play therapy. One model that has been used is the Early Start Denver Model (ESDM). ESDM is a relationship-based program that encourages positive feedback, shared activities, and parental involvement. The ESDM program is usually led by a therapist and starts when a child reaches one year of age.
The goals of the program are to increase social interaction while decreasing a child’s anxiety or confusion surrounding socialization, improve communication skills, encourage self-expression, and encourage situationally appropriate behavior and reactions.
Children participate in 20 hours of therapy a week in addition to structured playtime with caretakers at home until the age of four. In one study, children who participated in ESDM were given an electroencephalogram (EEG) while they looked at pictures of human faces expressing emotion. These children’s brain activity was higher than their autistic peers who did not receive ESDM.
Applied Behavioral Analysis (ABA)
In conjunction with the ESDM, many families opt to use Applied Behavioral Analysis (ABA) which also encourages a positive reward system and parental engagement with the program.
Applied behavioral analysis can be continued throughout a child’s schooling and be adapted to their current social and behavioral needs.
For example, ABA addresses daily tasks and reactions a child may encounter, such as responding to a lunch he/she does not like and progresses with the child until he/she has the skills to make a healthy lunch he/she will enjoy.
The program also encourages children to take ownership of their own emotions and responses to the level that is appropriate for them. Children with autism will learn how to effectively communicate their needs, preferences, and frustrations.
The program often includes family members in therapy sessions to practice skills in a safe, controlled environment before bringing them into the home. ABA has received the endorsement of the U.S. Surgeon General as well as several state health departments.
Additional therapies that can be integrated into your child’s care plan may include:
- Picture Exchange Communication System (PECS)
- Verbal Behavioral Intervention (VBI)
- Discrete Trial Training (DTT)
- Pivotal Response Training (PRT)
- DIR/Floortime therapy
Picture Exchange Communication System and Verbal Behavioral Intervention
PECS is ideal for children with limited or no verbal skills. It teaches children to communicate via pictures and symbols to express their needs and carry on a conversation. VBI is also used with children who struggle with verbal skills, but instead of communicating with pictures, it focuses on teaching verbal skills.
Discrete Trial Training and Pivotal Response Training
DTT and PRT focus on behavioral and motivational challenges a toddler with autism may experience. DTT breaks problems down into a series of step-by-step decisions a child can make to solve a problem.
Incorrect answers are typically ignored while correct answers and behaviors are praised. PRT builds upon these skills and focuses on developing a child’s motivation to manage behavior, communicate with others, and learn both in and out of the classroom.
While autism is most often diagnosed when a young child hasn’t met popular milestones during the formative years and/or when a child’s development has suddenly regressed, some experts believe there are signs that point toward an autism diagnosis earlier in a child’s life.
While not everyone who is autistic can be diagnosed as an infant, there are many benefits to receiving a diagnosis before reaching preschool age.
If your child is exhibiting signs of autism, even minor ones, be sure to document them and share your concerns with your child’s physician. The earlier a child with autism is diagnosed, the sooner families and specialists can work with the child using popular interventions and selected therapies.