Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects children’s social communication and behavior. There is wide variability in how autism might present in children, but in general there are differences in social/emotional understanding, use of language and gestures, as well as restricted interests and repetitive behaviors that impact daily functioning. Intellectual, adaptive, and motor skills are frequently delayed or impacted as well. Along with these challenges, individuals with autism can have special talents and heightened skills such as visual-spatial thinking and pattern recognition.
When to Test for Autism: Early Signs and Symptoms
How young can you test for Autism?
Autism can be reliably diagnosed by 18 months- 2 years of age. The American Academy of Pediatrics strongly recommends that all children be routinely screened for ASD in this age range. Understanding developmental milestones can help parents recognize potential signs early and seek an assessment.
Some early signs of ASD in infants and toddlers include:
Little or unusual eye contact
Does not respond to name by 9 months
Does not show a variety of emotional facial expressions like happy, sad, angry, and surprised by 9 months
Does not play simple back and forth games by 9-12 months
Uses very few gestures such as waving, clapping by 12 months
Lack of pointing and sharing interest by 12-15 months
Lines up toys
Repeats words or phrases over and over
Easily upset by small changes in routine or environment
Especially irritated by or seeks out certain smells, sounds, textures, sights
Unusual body movements such as flapping hands, flicking fingers, rocking, twirling
The prevalence of ASD has been steadily increasing, with current estimates around 1 in 44 children, according to the CDC. Autism occurs in all racial, ethnic, and socioeconomic groups, with non-white and female children being identified much later. Biases, stigma, lack of access to healthcare services, and non-English primary language are all potential barriers to identification of children with ASD.
The causes of autism are complex and not fully understood yet. We know there is a strong genetic component as well as a variety of environmental elements that all may play a role. The risk of ASD increases significantly if there is a family history. Some environmental factors that may increase risk include advanced parental age, prenatal exposure to certain drugs and toxins, the timing between births, assisted reproductive technology, and pre-mature birth. None of these alone are thought to directly cause autism. Rather it is an intricate interaction between multiple genetic and environmental factors .
During typical early development, the brain rapidly produces millions of new connections which are then gradually pruned or paired back to only the connections that are used most often. This allows the brain to become more efficient at learning. In autism, we see a lack of the pruning process and an abundance of connections, which may help explain some of the behavior difficulties children experience. There is too much “noise” going on, making it challenging for children with autism to know what to focus on.
Image shows brain cells and connections from a child with autism (L) and a typically developing child (R). Guomei Tang, PhD & Mark S. Sonders, PhD. Columbia University Medical Center.
There are many types of developmental and behavioral therapies that can be very beneficial to children with autism. Below is a list of common interventions. Your child may be recommended a combination of approaches to work on communication, sensory integration, reducing challenging behaviors, and increasing adaptive skills and the ability to connect with others.
Developmental: DIR/Floortime therapy is relationship-based and focuses on the synchrony/reciprocity of parent-child interactions during everyday routines. Therapy involves the parents and may be done at home. DIR focuses on back and forth play and emotional communication. Parents or therapists join the child’s play and work on expanding reciprocal interaction. Recently, developmental interventions have proven to have the best evidence for effectiveness with children with autism.
Behavioral: There are different types of behavioral therapy. They are mainly based on operant learning theory that targets specific skills and reinforces learning in highly structured interactions. Applied Behavior Analysis (ABA) is a very common therapy for children with ASD that uses a step-by-step approach allowing children to master one step before moving on to the next and also providing a reward system. It breaks down behavior into components and looks at the function of behavior.
Natural Developmental/Behavioral (NDBI): behavioral principles delivered via parent-child interactions and play; Early Start Denver Model; Pivotal Response Treatment are types of NDBI approaches.
Speech and Language therapy – Helps children with their ability to communicate verbally and non-verbally. It can help with articulation/pronunciation of speech as well as understanding/processing of language. Speech and language therapy can also help children understand the nuances of social communication to help them understand voice intonation, facial expressions, body movements, and hand gestures.
Occupational therapy – Works on skills children need for daily living such as dressing, feeding, toileting, writing, and playing. This can include emotion regulation and coping strategies for stressful situations, a well as targeted exercises to improve balance, body awareness, motor planning, sensory integration, grasp, and dexterity.
Physical therapy – Helps children with mobility issues, pain management, and restoring mobile function. It can address the ability to walk, throw a ball, or climb. It can also help improve balance and strengthen muscles.
Social skills – Many times children with autism have trouble understanding appropriate social interaction. This can make daily interactions at home, at school, or elsewhere difficult and stressful for children. Groups or individual services can help children learn skills such as social communication and interaction, how to correct repetitive behaviors or ticks, and other coping mechanisms.
Nutrition – Children with autism are more likely to have trouble with nutrition. They can have aversions to certain food textures or specific food sensitivities that make it difficult to eat a balanced diet. Working with a nutritionist can help you navigate these food issues and ensure that your child is receiving the proper nutrition.
Sleep – A professional that deals with sleep issues can teach you and your child healthy sleep habits as well as skills and coping mechanisms to reduce stress and anxiety around bedtime.
Mental health – Children’s mental health is an important part of their overall well being. Children with developmental delays and disorders as well as their families have a higher likelihood of being stressed, depressed, and anxious. Many different types of therapists, from psychologists to marriage and family therapists, can work with you and your child on coping mechanisms to enhance the mental health and wellbeing of your child and your family.