Early autism screenings can improve outcomes for children with signs of developmental risk.
The Benefits of an Early Autism Diagnosis
Many parents worry about their child’s early development. As they reach, or struggle to reach, each milestone parents may feel either pride or a growing sense of concern.
Unlike many parents whose children are diagnosed with autism, I did not worry about my daughter’s development during her first two years.
Hannah smiled socially, babbled, played and loved to show affection. She was known for grabbing onto the face of those she loved and focing her slobbery kisses all over them.
Hannah did not really show any signs that led me to become concerned until she was two years old. All of the sudden she became a different baby. She would scream. She was miserable. The terrible twos were never like this with her older sister. I decided to take her to the doctor.
The answer was simple. She had an ear infection. I was relieved. Except the symptoms did not stop with a dose of antibiotics.
The next step was to take her to one of the growth check up clinics run by the Ontario Early Years. I explained my concerns about my daughter’s behaviour. I was reassured that it was completely normal for a two-year old.
The wait list for support was a year long. I was assured that by the time she turned three she would have grown out of it.
One year later the behaviour had not improved. She was seen by a developmental paediatrician who was not able to determine what was causing the behaviour, but she assured me it wasn’t autism.
She was wrong. It took two more rounds of testing and three more years before Hannah was diagnosed.
My daughter has autism. She can make eye contact, attend school and have friends and yet she is also on the spectrum.
Why is Autism Difficult to Diagnose?
Hannah’s case is not uncommon. According to Autism Speaks, although autism can be reliably diagnosed by age two, the average age of diagnosis is not until age 5.
My child’s gender may have played a part since boys are four times more likely to be diagnosed with autism than girls. She is also a very bright child. While autism can be linked with learning difficulties (31% of children with ASD have an intellectual disability and 25% are in the borderline range) not all children will have this symptom. My daughter belongs to the 44% of people with autism who have IQ scores in the average to above average range.
Autism is a spectrum, so no two cases are exactly alike. A person with autism may experience mild delays or may face major obstacles in their lives. No matter where a child presents on the spectrum, experts agree that early intervention is key.
What is Autism?
Autism Spectrum Disorder often appears in infancy or early childhood as a delay is basic development, such as walking, talking and building social skills.
In general, children with autism experience difficulty in:
- Verbal and non-verbal communication
- Relating to others and the outside world
- Showing flexibility in their thoughts and behaviours
What Causes Autism?
Autism has no one cause, but has several genetic and non-genetic risk factors. Autism can run in families and may be passed down genetically from a parent or parents who carry the gene, even if they do not have autism themselves. Changes to the embryo during early pregnancy can also increase the risk of autism.
- Advanced parent age (either parent)
- Pregnancy and birth complications e.g. extreme prematurity (before 26 weeks), low birth weight, multiple pregnancies (twin, triplet, etc.)
- Pregnancies spaced less than one year apart
- Prenatal vitamins containing folic acid, before and at conception and through pregnancy
No effect on risk
- Vaccines. Each family has a unique experience with an autism diagnosis, and for some it corresponds with the timing of their child’s vaccinations. At the same time, scientists have conducted extensive research over the last two decades to determine whether there is any link between childhood vaccinations and autism. The results of this research is clear: Vaccines do not cause autism. The American Academy of Pediatrics has compiled a comprehensive list of this research.
Differences in brain biology
How do these genetic and nongenetic influences give rise to autism? Most appear to affect crucial aspects of early brain development. Some appear to affect how brain nerve cells, or neurons, communicate with each other. Others appear to affect how entire regions of the brain communicate with each other. Research continues to explore these differences with an eye to developing treatments and supports that can improve quality of life.
What are the Signs of Autism?
According to Autism Speaks, some children may show signs of autism in infancy, and others as late as two or three years of age. Some children may also show some signs of autism and not have the disorder. It is important to have your child evaluated professionally.
By 6 Months:
- Is your child giving you big smiles and other engaging or joyful expressions?
- Does your child avoid eye contact?
By 9 Months:
Is your child able to mimic the smiles, sounds or expressions you make?
By 12 Months:
- Does your child respond to their name?
- Will your child wave, point or gesture?
- Is your child babbling?
By 16 Months:
Does your child only have a few words?
By 24 Months:
Is your child able to say two-word sentences (this does not include repeating or imitating)
Warning Signs at Any Age:
- Loss of previously acquired speech, babbling or social skills
- Avoidance of eye contact
- Persistent preference for solitude
- Difficulty understanding other people’s feelings
- Delayed language development
- Persistent repetition of words or phrases (echolalia)
- Resistance to minor changes in routine or surroundings
- Restricted interests
- Repetitive behaviours (flapping, rocking, spinning, etc.)
- Unusual and intense reactions to sounds, smells, tastes, textures, lights and/or colours
While no two children are alike, many children with autism will show signs in their development. Dr. Nerissa Bauer of Your Doctors Online said there are early signs of autism that parents can look for in their young child such as:
- Not responding to their name
- Inability to make or keep eye contact
- Not responding to a parent’s smile
- Refusal to look at objects a parent is pointing or looking at
- Not bringing or showing objects of interest to the parent
- Delayed speech (i.e. no single words by 16 months, doesn’t start conversations, repeating what is being said without appearing to understand meaning)
Dr. Bauer said when it comes to a suspected diagnosis, it is important to trust your gut.
“Write down anything that comes to mind and keep a record of your concerns,” she said. “You know your child best since you have the opportunity to witness their development firsthand.”
The first step is to speak to your family doctor about your concerns. Dr. Bauer noted that parents should expect to be asked about their observations and concerns. Writing down specific instances and information can be helpful before your visit.
“The doctor will want to know specifics of the developmental concern including when you first started worrying and why, they will ask about the pregnancy and delivery, developmental course to date and family history,” she said.
Your Doctor May Also Ask About:
- Your child’s overall development. Was their development delayed? Did they experience regression?
- Has your child had a hearing test?
- Can your child indicate their wants and desires?
- Did your child respond to their name or return a smile as an infant?
- Will your child play with others or do they prefer to play alone?
- If older than 18 months, will your child do pretend play?
Parents of toddlers between 16 and 30 months of age can answer a modified checklist for autism in toddlers (M-CHAT-R). This is a series of questions that can help pinpoint behaviours associated with autism. This can inform parents if further evaluation is needed.
Why is Early Intervention Important?
Research has indicated that early intervention can improve a child’s overall development. Children who receive early intervention and support are able to build the necessary social skills and tools to better engage in society.
According to Dr. Bauer, screening by pediatricians is recommended at 18 and 24 months during well child visits to the clinic.
“Early intervention can improve a child’s overall development,” she said. “It is important that parents play an active part of the process and learn relationship-based techniques during everyday moments to engage and interact with their child.”
Many children affected by autism also benefit from other interventions such as speech and occupational therapy. Applied behaviour analysis (ABA) and therapies based on its principles are the most researched and commonly used behavioural interventions for autism.
Developmental regression, or loss of skills, such as language and social interests, affects around 1 in 5 children who will go on to be diagnosed with autism, and it typically occurs between ages 1 and 3.
Early intervention can also benefit parents who can learn the skills to better support their child’s mental, physical and emotional health throughout their different stages of development. Parents can also access support groups to help with the challenges of raising a child with autism.
Early Start Denver Model
The Early Start Denver Model (ESDM) is a type of behaviour therapy for children with autism aged 12-24 months. This therapy uses Applied Behaviour Analysis (ABA) methods to boost language, cognitive and social skills through play.
One studyof 48 toddlers aged between 18 and 30 months were divided into two groups and given two different types of early interventions. One was given ESDM therapy and the other groups received more common interventions available in the community.
The group that received the ESDM intervention showed significant improvements in IQ, adaptive behaviour and autism diagnosis when compared with the group who received community interventions.
Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group.
In addition, research using brain scans has shown that ESDM has the ability to improve brain activity that controls social and communication skills.
“The Early Start Denver Model was highly effective in improving outcomes for toddler-aged children,” said Dr. Bauer. “The earlier intervention is begun, the better.”
Challenges Associated with Autism
Autism can also come with medical, emotional and safety cocerns. Each case is different and so are the symptoms experienced by the child. Here are a list of symptoms that children with autism may experience.
Many children with autism have safety issues as an estimated one-third of people with autism are nonverbal. In addition nearly half of those with autism wander or bolt from safety.
Drowning remains a leading cause of death for children with autism and accounts for approximately 90 percent of deaths associated with wandering or bolting by those age 14 and younger.
Children with autism can also be a danger to themselves as many self harm with behaviours such as head banging, arm biting and skin scratching.
Children with autism often have trouble reading social cues. Nearly two-thirds of children with autism between the ages of six and 15 have been bullied. Anxiety and depression are also common among children and adults with autism. Anxiety disorders affect an estimated 11 to 40 percent of children and teens on the autism spectrum. Depression affects an estimated seven percent of children and percent of adults with autism.
Autism is also linked to a variety of medical challenges, and a higher instance of ADHD, epliepsy, chronic gastrointestinal issues, sleep disorders, obesity, and schizophrenia.
My Child Has Been Diagnosed. Now What?
Families who receive the diagnosis may feel so many different feelings–from shock, denial, guilt, and sadness.
“These feelings are normal,” said Dr. Bauer. “It is important to take the time to sit with those feelings and reach out for help and support. It can be overwhelming.”
Dr, Bauer said that your family doctor can help to build a team around you for services and therapies to help your child and your family.
“Don’t be afraid to ask questions so you can become the best advocate you can for your child.”
She suggests seeking out evidence-based therapies such as Applied Behaviour Analysis (ABA) and ensuring that you have respite options for yourself (you can’t give your child 110% if you don’t take the time for self-care).
Dr. Bauer also suggested reevaluating your child’s needs as they grow.
“Each year allows the team to look at the progress your child has made, what ongoing challenges are occurring and gaps in support you and your child need. Make sure you ask for help and write down any and all questions you have,” she said.
The most important advice Dr. Bauer offered to parents concerned with their children’s development was to be proactive.
“While children all develop at different rates, when it comes to developmental delay, it cannot be solved by a wait and see approach,” she said. “Parents are encouraged to take note of their concerns with their child’s development and speak to their pediatrician.”
It may have taken four years to get a formal diagnosis for my daughter, but I fought every step of the way for her. As parents we are on the front lines noting behaviours, meeting with educators, attending therapies and being the voice for our children. My daughter’s diagnosis does not define her. Instead, it is just a part that makes up the beautiful girl she is and the woman she will become.
Are you concerned about your child’s development? Check out the Autism Speaks screening questionnaire and share the results with your family doctor.
Melissa Robertson is a journalist with 15 years of experience as a professional writer. She is also a hot mess mom to three very energetic daughters, and loves to DIY, share design and upcycle projects and creating patterns. She shares it all on her blog, Keeping Up With The Robertsons and, luckily, has a husband who is a total softie and is usually willing to go along with her crazy plans!