EARLY DIAGNOSIS

Eligibility Criteria Age 0 to 4+ Years Gross or fine motor development

When there is a deficit in executive functions, it manifests itself in inattentiveness, distractibility and impulsivity—three areas recognized on both the autism and ADHD checklist of behaviors.

Possible Red Flags for Autism Spectrum Disorders Children and adults with an autism spectrum disorder might:

  • Not play “pretend” games (pretend to “feed” a doll)
  • Not point at objects to show interest (point at an airplane flying over)
  • Not look at objects when another person points at them
  • Have trouble relating to others/ not have an interest in other people at all
  • Avoid eye contact and want to be alone
  • Have trouble understanding other people’s feelings or talking about their own feelings
  • Prefer not to be held or cuddled or might cuddle only when they want to
  • Appear to be unaware when other people talk to them but respond to other sounds
  • Be very interested in people, but not know how to talk to, play with, or relate to them
  • Repeat or echo words or phrases said to them, or repeat words or phrases In place of normal language (echolalia)
  • Have trouble expressing their needs using typical words or motions
  • Repeat actions over and over again
  • Have trouble adapting to changes in routine
  • Lose skills they once had (for instance, stop saying words they were once using)

Recommendation: Talk to your child’s doctor or nurse if your child loses skills at any age.

Identifying Autism

0 - 3 Years

Until recently, diagnosis of autism was often delayed until mid-childhood, especially if language delay was not present. Retrospective reports suggest that most parents identify the onset of first concerns at about 18 months of age, or earlier. Some symptoms can be exhibited very early on especially in the areas of eye contact, crying, making sounds (babbling) to gain attention, as well as skipping stages, like going from sitting up to standing and walking, without crawling first. Parents may notice an unusual rolling/flip flop movement in lieu of typical hand/knee coordinated crawling. An infant may not want to be held face to chest, but prefer to be held faced away from chest, seemingly not wanting to be cuddled, even during bottle feeding. Nursing infants may feed then abruptly wiggle, arch their back and cry, to change positions away from cuddling.

Autism signs early in childhood

Lack of social smile, lack of appropriate facial expression, poor attention, impaired social interaction
Ignoring people, preference for aloneness, lack of eye contact, lack of appropriate gestures, lack of emotional expression, less looking at others, less pointing, less showing objects in the second year.

Alerting signals of possible Autistic Spectrum Disorder

In the first year of life there are usually no clear discriminating features, but parental concerns should be elicited Between 2 and 3 years of age, concerns in the following areas should prompt referral.

Communication

Impairment in language development, especially comprehension; unusual use of language; poor response to name; deficient non-verbal communication—for example, lack of pointing and difficulty following a point and failure to smile socially to share enjoyment and respond to the smiling of others.

  • Absolute indicators for referral.
  • No babble, pointing or other gesture by 12 months.
  • No single words by 18 months.
  • No two word spontaneous (non-echoed) phrases by 24 months.
  • Any loss of any language or social skills at any age.

Limitation in, or lack of imitation of, actions (for example, clapping); lack of showing with toys or other objects; lack of interest in other children or odd approaches to other children. Minimal recognition or responsiveness to other people’s happiness or distress; limited variety of imaginative play or pretence, especially social imagination (that is, not joining with others in shared imaginary games), “in his or her own world;” failure to initiate simple play with others or participate in early social games; preference for solitary play activities; odd relationships with adults (too friendly or ignores).

Impairment of interests, activities, and other behaviors

Over-sensitivity to sound or touch; motor mannerisms; biting, hitting, or aggression to peers; oppositional to adults; over-liking for sameness or inability to cope with change, especially in unstructured setting; repetitive play with toys (for example, lining up objects); turning light switches on and off, regardless of scolding.

School Age

Features that may discriminate children with autism in later childhood In school age children, the following features should alert teachers and others to the possibility of autistic spectrum disorder and trigger discussion with parents and possible implementation of the local referral pathway.

Communication impairments

  • Abnormalities in language development, including muteness and odd or inappropriate prosody.
  • Persistent echolalia.
  • Reference to self as “you,” “she,” or “he” beyond 3 years.
  • Unusual vocabulary for child’s age or social group.
  • Limited use of language for communication or tendency to talk freely only about specific topics.

Social impairments

  • Inability to join in with the play of other children or inappropriate attempts at joint play (may manifest as aggressive or disruptive behavior)
  • Lack of awareness of classroom “norms” (criticizing teachers; over unwillingness to cooperate in classroom activities; inability to appreciate or follow current trends—for example, with regard to other children’s dress, style of speech, or interests)
  • Easily overwhelmed by social and other stimulation
  • Failure to relate normally to adults (too intense or no relationship)
  • Showing extreme reactions to invasion of personal space and extreme resistance to being “hurried”