Autism: Early Red Flags

One of my jobs as a pediatrician is to encourage child development and screen for developmental disorders such as autism. (In 2013, the diagnosis "autism spectrum disorder" or ASD replaced the previous diagnoses of "autism," "Asperger syndrome," "childhood disintegrative disorder," and "pervasive developmental disorder, not otherwise specified"¹. Here, I’ll use “autism” because that is the term with which most people are familiar.) Individuals with autism have 1) difficulty with social interactions and 2) restricted, repetitive patterns of behavior, interests, or activities². I see many parents who are concerned that their toddler might have autism. Some signs of autism are present by age 2, and early therapy can have a positive influence, so screening for autism is an important part of well-child care. (It is recommended to have a formal developmental screen at 9, 18, and 24-30 months of age.)²

How can you tell if your child might have autism? Young children tend to have behavior that would be unusual for an adult. Sharing in your toddler's quirky and imaginative world is part of the joy of parenting. However, the following warning signs may indicate that a child is not developing typically. These signs DO NOT mean that your child definitely has autism. But if you see these signs, it is worth raising the issue with your pediatrician.

Red flags that might indicate a developmental problem include the following^1,3:

• No babbling by 12 months
• No gesturing, pointing, or waving bye-bye by 12 months
• Not using single words by 16 months
• Not using 2-word spontaneous phrases by 24 months. (A spontaneous phrase means the child came up with it herself, and is not just repeating what you say.)
• Loss of any language or social skills at any age
• Rocking back and forth, spinning in circles, or wandering aimlessly around a room
• Repeating words over and over

Here are some other warning signs if your child is 18-24 months or older:⁴

• Does not take an interest in other children
• Does not use her index finger to point at something interesting
• Does not bring an interesting object (for example, a toy or a flower) over to show you (the parent)
• Does not imitate you
• Does not respond to her name
• Does not look when you point at something

Note that if your child has a physical disability — such as a problem with hearing or vision, or a mobility deficit — she may have some of these warning signs due to her physical condition, not because of autism.

Parents often worry that their child is too shy, or that his tantrums are out of control. A shy child my develop friends slowly and take a long time to become comfortable in a new setting, but he wants and tries to share experiences with others. In general, a child with autism tends not to be interested in relationships, prefers to play alone, does not make eye contact even with familiar people, and does not share in back-and-forth conversation. Similarly, almost all toddlers throw tantrums as they struggle to express themselves and exert control. Tantrums may be abnormal and a sign of a developmental problem if they: persist past age 3; occur more than 5 times daily on multiple days, especially outside the home; regularly last 30 minutes or more; involve aggression towards self or parents; are exaggerated or without a clear pattern; and if the child is unable to calm himself³.

Again, the presence of one or more of the signs listed above DOES NOT mean your child has a diagnosis of autism. However, you should bring it up with your friendly neighborhood pediatrician so he or she can look into it further. (That's why we're here!)

Remember, this is general information that applies to most children. It is not meant to substitute for the medical advice of your healthcare provider. Please talk to your pediatrician if you have any specific questions or concerns about your child.

SOURCES CITED

1.     CDC Autism Spectrum Disorders. http://www.cdc.gov/ncbddd/autism/index.html, accessed 11/13/14.

2.     Clinical Report: Identification and Evaluation of Children With Autism Spectrum Disorders. Pediatrics. 2007;120(5):1183–1215

3.     Autism Case Training: A Developmental-Behavioral Pediatrics Curriculum. http://www.cdc.gov/ncbddd/actearly/act/class.html?mobile=nocontent Accessed 11/1/14.

4.     Robins, DL. Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F). Pediatrics 2014;133(1):37-45

Dr. Ben Kleifgen is a pediatrician with First Steps Pediatrics and Adolescent Medicine in western Pennsylvania and surrounding areas of West Virginia and Ohio. He graduated from Temple University School of Medicine and completed his pediatric residency at the University of Arizona in Tucson.