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.
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.
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.
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).
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.
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.
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