The first five years of a child's life are a period of remarkable growth and development. Babies learn how to communicate their needs using physical gestures and spoken language. Toddlers discover how to play "pretend" using their newly-forming imagination. And preschoolers acquire the fine motor skills to begin using tools like scissors.
For the 1 in 54 children born with autism spectrum disorder (ASD), this is also the time when signs of their condition become more apparent in the form of developmental delays or distinct behaviors.
Research shows that early intervention services like behavior therapy and speech therapy can dramatically improve long-term outcomes for children with ASD. But for new parents, recognizing the signs and knowing when to seek help from medical professionals isn't always easy.
In this article, we will:
People with autism spectrum disorder experience a wide range of social, communication, and behavioral challenges. For example, a child with autism might have difficulties initiating conversations or sharing toys with their peers.
However, as stated in the diagnosis, autism covers a broad spectrum, which means that it manifests differently in every person. For example, one person may be completely nonverbal, while another uses single words or short sentences to communicate their needs. This fact can make identifying and diagnosing autism a challenge for parents and professionals.
According to this guidance from the American Academy of Pediatrics, there are a few early indicators of autism. Below is their summary of these key developmental differences and how to recognize them by becoming aware of their effect on your child’s social and emotional skills, communication, and behavior.
Social and emotional skills measure your child's ability to interact with others and exercise self-control.
Children with autism often have difficulties:
Communication skills include your child's proficiency in understanding and using language to express needs and emotions.
Children with autism may:
Restrictive and repetitive behaviors or interests are among the defining symptoms of autism.
Here are some examples (Note: most children will do any one of these once and a while; it is the repetitiveness of the behavior that marks it as abnormal):
Here are behaviors that should give you confidence that your child’s development is on track, as noted by Dr. Wendy Sue Swanson in her book, Mama Doc Medicine:
Pediatricians use a set of known developmental milestones to measure your child's skills in different development areas during well-child visits. Between appointments, there are clinically-validated tools available for you to do the same.
Being aware of and tracking your child's developmental milestones at home will ensure that your child progresses as expected. You will also be able to identify delays early and seek the necessary supports.
There are dozens of free or low-cost developmental milestone tracking tools available to you, including:
If your child is between 16 and 30 months old, another tool at your disposal is the Modified Checklist for Autism in Toddlers (M-CHAT). The M-CHAT is a ten-minute screening survey designed to help you learn whether your child could benefit from further developmental evaluations. This survey is generally given at your child’s 18- and 24-month well-child visits, so make sure not to miss those important screenings!
The M-CHAT asks simple questions like, "Does your child try to copy what you do?" and "Does your child like movement activities?" Based on the score you calculate at the end of the assessment, the M-CHAT website recommends appropriate next steps, which could include contacting your pediatrician.
The M-CHAT is available for free in multiple languages at M-CHAT.org.
It’s important to be aware of the distinction between screenings and evaluations, which have two very different utilities in the identification and diagnosis of ASD:
All of that to say, do not be alarmed if the results of your child’s M-CHAT screening indicate a “high risk for autism.” Follow the screening’s recommended next steps and book an appointment with your pediatrician for further evaluation.
If your child shows signs that might indicate a disorder on the autism spectrum, receiving a formal diagnosis will unlock a suite of support services that can ultimately improve long-term outcomes. For this reason, it's critical to act early.
Here are a few steps that you can take if you have additional questions or concerns about autism.
First, make an appointment with your child's pediatrician. Let the office know that you have concerns about your child's development and would like a visit for a screening and assessment.
Before the doctor's appointment, write down a list of your concerns and print any relevant materials, like a completed checklist of developmental milestones or the M-CHAT screening results. Coming prepared with information will help the doctor move along more quickly with an appropriate plan of action.
If you've already met with your pediatrician and still have concerns, contact another doctor in your network for a second opinion.
To find providers in your area who are accepting new patients, try consulting with families who have previously sought medical advice for their child’s development — they tend to have the best leads! Otherwise, websites like Zocdoc and Healthgrades have searchable databases of pediatricians you can utilize.
Remember, you know your child better than anyone else does! Don't hesitate to advocate on their behalf if you're unsatisfied with the advice you receive.
In addition to your pediatrician, certain specialists can help you find answers about your child's development, including:
If you think it may be useful to speak with one of these specialists for further evaluation, ask your doctor for a referral. And if, after an assessment by your child’s pediatrician, you are referred to one of these specialists, make sure you follow through for a full evaluation.
While you're waiting to meet with your doctor, contact early intervention (EI) services to request a free evaluation. Although you do not need a medical diagnosis to receive these services, a referral by a doctor, parent, family member, or childcare provider will likely be required.
Early intervention services are available to families at no cost. They are customized to the child's needs and may include physical, occupational, behavioral, and speech therapies, and special education.
Before seeking developmental evaluations, families should understand that the process of receiving an autism diagnosis can be arduous and time-consuming. In fact, it's come to be known as the “diagnostic odyssey” among some who have experienced it.
While the signs of autism can sometimes be detected in a child at 18 months old, studies have shown that most children are not formally diagnosed until after 3 years of age. There are several factors that contribute to this delay, including:
To that end, it’s critical for your child to enroll in early intervention services as early as possible to begin receiving support services while you're navigating the evaluation and diagnostic process.
While the prospect of their child having a developmental delay is worrisome for many parents, there are more reasons than ever to be optimistic. Awareness about disorders like ASD continues to increase, along with medical experts' understanding of how to better identify and treat them. For parents, access to guidance, resources, and peer support communities is also improving. Remember to stay positive, seek out the best information, and continually advocate for your child's health.
