How to look out for early signs of Autism Spectrum Disorder in children between 0-3 years old?


This is for a variety of reasons as research have shown that identifying symptoms at an earlier age can significantly improve results of early intervention, leading to better outcomes in the long term when started early, as compared to when started at a later age, and help to bring on cost-savings in the long term for families.

Despite the various benefits of starting intervention at an early age, most children do not receive the much-needed attention until later. Some caregivers may only begin to explore treatment options after receiving a formal diagnosis which may be delayed until the child attends school between 3-5 years old. According to a study, the average age of diagnosis for ASD was 3 years old, which coincides with the time where the child is starting out in preschool, or in some cases, have already been attending playgroups or childcare for a year or more. Although our current understanding of ASD has allowed clinicians to diagnose the condition reliably by the age of 3, new research is emerging to show that ASD can be diagnosed earlier than thought, and some of these symptoms may even appear before a child is 2.


Look for consistent eye-contact

Eye contact, although not a diagnostic criteria for autism, offers a crucial foundation for much social and communicative learning to take place. It is also one of the earliest symptoms that parents notice amiss about their child. Not being able to sustain eye contact can lead to lost opportunities in developing social and communicative skills, and becomes a difficulty that many children with ASD struggle with. On the DSM-V, such “Persistent deficits in social communication and social interaction across multiple contexts” meets one of the diagnostic criterias for ASD.


In trying to understand and identify early symptoms of ASD, a ground breaking study tracking high-risk infant’s eye-gaze found that babies who go on to develop autism typically start out with normal patterns of eye gazes, but they gradually decline after the first 2 months of age, while babies who do not develop autism show a steady increase in eye contact after 2 months old. Before any of us start panicking about our babies’ eye-gazes, the research concluded that these subtle changes can only be detected with eye-tracking technology, and may not be captured by the human eye. The key here is to observe and keep a look out for reduced and inconsistent eye contact since studies have shown that eye contact can start to decline between 2-6 months of age. Some of these symptoms can appear in the form of:

  • Avoiding eye contact

  • Not responding to their names when called

  • Not responding to smiles or other facial expressions

  • Not looking at an event or object that a parent is pointing to


Children at risk of ASD have odd play skills

Many children with ASD also display unusual interest or strong fixations in the form of “Restricted, repetitive patterns of behavior, interests, or activities”. However, these repetitive behaviours may be hard to detect early on as babies tend to repeat certain activities that interest them (such as dropping a toy and watching it fall), and it can be hard to differentiate if the child is just having fun or at risk of developing autism. Additionally, parents should look out for an important skill known as shared attention, a major developmental milestone usually achieved by 12 months of age. From 12 to 18 months, typically developing toddlers usually show awareness of others and enjoy interacting with them. Conversely, same-aged toddlers who may be at risk of developing autism are generally unable to:

  • Point at objects of interest to draw an adult’s attention and maintain social connection

  • Check back with caregiver while exploring a toy to show awareness of caregiver

  • Engage adults or others in their play by “offering” toys or requesting for help

  • Give eye contact to “share” enjoyment of an activity

  • Imitate adults and incorporate new ways of playing with toys

  • Use eye contact, gesture and vocalisation in a coordinated manner to communicate


In addition to their lack of social interest, they may also display intensive interest in an item, or explore toys in an unusual manner. They may prefer to:

  • Line up toys or objects

  • Play with toys the same way every time

  • Focus on parts of an object (e.g. wheels, doors)


Observe for prolonged sensory behaviours

One of the main criterias under the DSM-V lists “Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).” as a common occurrence in children on the spectrum. In one study, researchers found that children between 2-3 years old who met criteria for a diagnosis of ASD displayed significantly more sensory behaviours than children who were typically developing. Also, they found that their sensory behaviors appeared relatively early, and persisted throughout childhood up to 8 years of age. Common sensory behaviours may include:

  • Rocking body, flapping hands, and spinning in circles

  • Repeated visual examination of objects or toys

  • Covering ears to protect from sounds

  • Insisting on a limited choice of food/ avoiding certain tastes or food smells

  • Frequently bumping into or touching other people

  • Getting distracted by a lot of loud sounds

Get your child screened regularly by your paediatrician

Typically, children are screened for autism and other developmental delays around 18 months. According to the American Academy of Pediatrics (AAP), screening for ASD is recommended for all children between 18 and 24-month in addition to regular physical and developmental check-ups. This is for a variety of reasons as research have shown that identifying symptoms at an earlier age can significantly improve results of early intervention, leading to better outcomes in the long term when started early, as compared to when started at a later age, and help to bring on cost-savings in the long term for families. If you are still unsure of your child’s development, the best way is to avoid skipping those visits to the paediatrician as they would be better trained in picking up early signs of ASD.


Written by Marjorie.




References


https://www.cdc.gov/ncbddd/autism/hcp-dsm.html


https://www.healthychildren.org/English/health-issues/conditions/Autism/Pages/Early-Signs-of-Autism-Spectrum-Disorders.aspx


https://nationalautismassociation.org/resources/signs-of-autism/


https://www.autismspeaks.org/science-news/study-eye-contact-declines-early-babies-who-later-develop-autism


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861294/#R13


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918912/


https://www.youtube.com/watch?v=YtvP5A5OHpU&t=116s


https://www.whattoexpect.com/first-year/wave-clap/


https://www.healthychildren.org/English/health-issues/conditions/Autism/Pages/How-Doctors-Screen-for-Autism.aspx

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