Progress in the area of autism identification is significant: awareness of autism continues to rise; pediatricians’ offices routinely screen for autism; and treatment providers are more available. This is reflected in the most recent report by the Centers for Disease Control and Prevention, which found that prevalence of autism among 8-year-old increased (1 in 59 nationally), and gaps in gender and ethnicity narrowed. These likely reflect improved identification. Importantly, even though autism can be reliably diagnosed by age 2, the median age of earliest diagnosis was 4 years 4 months. Also, 85% of the 8-year-olds studied had developmental concerns noted in records by the age of 36 months, but only 42% received a comprehensive development evaluation by 36 months, a proportion which hasn’t changed since 2006! Even though we can accurately and reliably diagnose autism beginning around 2 years old, this is, unfortunately, not the norm – based on this data.
Why is it important to identify autism early? Children who are identified early (2-4 years) and receive intervention demonstrate improved outcomes and significantly less severe symptoms several years later.
We need continued understanding and awareness about the red flags for autism. We also need to connect these red flags to conversations and action. As you read these red flags, it is important to remember that autism is a constellation of symptoms. The presence of one of these red flags does not constitute an autism diagnosis. However, a red flag should prompt a conversation with a knowledgeable professional about your child’s development.
Red Flags for Autism:
- Does not consistently respond to his/her name.
- This should be happening consistently by 9 months in a child without any hearing difficulty
- Lack of appropriate eye gaze
- Typically developing infants tend to look at their parents faces and eyes a considerable amount. Lack of spontaneous eye contact (i.e. your toddler anticipates you turning your face towards theirs and locks eyes with you when you do) can be a red flag
- Lack of imitation
- Older infants and toddlers imitate silly faces , noises, and actions parents make on a regular basis. This social imitation is a big medium through which children learn! These imitation skills take longer to develop in children with autism.
- Does not use a single finger point
- This seems like an odd one – why does a single-finger point matter? Children with autism tend not to point out objects or things in the environment just to share the experience with another person (sharing vs requesting). We frequently engage in “sharing” with others through a single finger point and eye contact. This skill develops in late infancy/ early toddlerhood.
- Does not seem interested in playing with you or others.
- This child just may be very independent. However, children with autism may not initiate play or contact with others at the same frequency. They may also be delayed in parallel play or lack interest in activities the parent tries to engage in with them
Red flags are also seen in play behaviors:
- Lack of appropriate play behavior
- Toddlers develop the ability to push a car functionally in early toddlerhood. The child uses the toy largely in the way it is intended (pushing along with little accompanying noises). This type of play is followed closely by creative play such as pretending to talk on the phone, hugging a baby doll, or stirring a bowl with a spoon. Children with autism may have delays in the development of these skills.
- Repetitive Motions or actions with toys
- In a toddler, this could range from repetitive throwing, spinning, or rotating toys to predictably playing with a toy in a particular manner. If the child plays or handles a toy in a way that is different than expected, often enough that the parent notices, it can be a repetitive motion
- Repetitive movements or vocalizations
- Hand movements, such as putting hands near eyes and wiggling fingers or flapping hands when excited/not excited, can be a red flag. Also, if you hear the same noise from your child over and over, but it is not communicative or directed towards someone (such as a “hah-hah-hah” noise that is not meant to communicate anything), this may be a red flag.
We know that autism can be identified in toddlerhood or perhaps even earlier. Resources and interventions are available to help children make progress. Early, efficient evaluation and identification clears the way for these interventions to be implemented sooner. If your child exhibits any of these red flags, be sure to talk about it with your child’s pediatrician or an expert in child development.