If you've ever found yourself observing your baby or child's behavior and wondering if they might be on the spectrum, you're definitely not alone. It's a question many parents have (and one I've admittedly asked myself and my pediatrician before). According to the most recent statistics from the Center for Disease Control, 1 in 59 children are on the autism spectrum — which means it's a very real possibility for many families.
Nonetheless, diagnosis is often missed or delayed, especially in underrepresented communities. In fact, latino and African American children are less likely to be identified on the spectrum than their white peers, demonstrating a potential gap in identification among underserved groups. And, the earlier autism can be detected, the better.
In an effort to raise awareness around the importance of diagnosing autism early across all populations, Autism Speaks has partnered with Sesame Street to launch a public campaign featuring Julia, a four-year-old puppet with autism. And, in honor of World Autism month, we were lucky enough to learn more from Dr. Thomas Frazier, Chief Science Office at Autism Speaks.
Mabel + Moxie: What signs should parents look for in children two and younger that they might be autistic?
Dr. Thomas Frazier: Parents can look out for a number of things. In young children starting on or before six months old, the child should show reciprocal social smiling. When parents smile at children, the children should pay attention to the parent and smile back. Some children with autism show fascination with lights and other sensory experiences that are out of proportion to what you would expect, and they can even show these traits when they are very young.
In general, very young children should pay attention to social information like parents’ faces and following the parent when they move into their visual field instead of paying attention to other non-social sensory things like bright lights or running water.
By 12 months children should be babbling and using sounds as if they are talking (not randomly saying things without communication intent)
By 16 months children should be using single words
By 24 months they should be putting two words together
Before age 2 you should see some reciprocal play with parents (back and forth interaction, even if only a few turns)
Young children should be using gestures, including pointing and should also initiate and respond to joint attention (pointing something out and then checking in with the other person to make sure they are looking). Not responding to their name when called is also one of the most reliable early signs of autism. Another potential signs is any regression in skills, regression in language/communication, eye contact or play skills. Parents can also visit Screen For Autism or Deteccion De Autismo (in Spanish) for more information on the signs of autism, screening resources and other helpful information.
M+M: What about signs in preschool aged children?
Dr. Thomas Frazier: You might notice preschool-aged children with autism having problems with reciprocal interaction or toy play, repeating discussions on the same topic and not seeming interested in playing with other children or people including their parents. Other signs including excessively lining up or ordering things, insisting parents say the same thing in the same way, problems with imaginative play or social imitation, repetitive behavior or repetitive motor mannerisms (flapping hands, spinning in place, staring at objects) or lack of eye contact (avoiding eye contact or only looking very briefly or infrequently).
M+M: Why is it helpful to identify autism early?
Dr. Thomas Frazier: It is key to identify signs early because early developmental and behavioral intervention is effective. Getting kids into intervention early can change the course of autism, improve the child’s developmental trajectory and help to prepare them for future educational and social experiences.
M+M: If a parent is concerned their child might have autism, what are the first steps they should follow?
Dr. Thomas Frazier: The first step is to talk with your pediatrician. As part of the process, you should be completing a screening measure, often the Modified Checklist for Autism in Toddlers. Parents can complete this through the Autism Speaks website (available in multiple languages) and many pediatricians will also use the M-CHAT. If the screening is positive, then it is important to see an expert in diagnostic evaluation for autism. Often these clinics are at academic medical centers and involve multi-disciplinary teams including pediatric psychologists, pediatricians or other physicians, speech language pathologists. The evaluation often will include a gold standard instrument such as the Autism Diagnostic Observation Schedule – Second Edition (ADOS-2).
M+M: What types of interventions are available to young children with autism?
Dr. Thomas Frazier: Many children should receive intensive behavioral intervention. For some very cognitively-able children, the intensity of the intervention may be less and will focus more on social skills (assuming that communication, daily living and pre-academic skills are at age level). Parental training in developmental and behavioral techniques is also effective.
For older, cognitively-able (high functioning) children, social skills interventions can be effective. Many children may also need speech language therapy to improve communication and occupational and/or physical therapy for motor skills. For non-verbal or minimally-verbal children some form of alternative, augmentative communication is often taught by a speech language pathologist and adopted by other therapists and caregivers.