Seven signs your child may have autism
Tips to help spot autism
Research shows that early intervention is beneficial for children with autism spectrum disorder, but on average children aren't diagnosed until age four or five. That's about two years later than is possible, according to the US Centres for Disease Control and Prevention.
Part of that delay is undoubtedly because autism spectrum disorder (ASD) is a developmental disorder that has widely ranging symptoms from mild to severe. Also, any symptoms a child is experiencing may not be immediately evident in toddlers.
What is clear is that at some point children with autism show deficits in social interaction, language and imaginative play.
"Too often, doctors take a wait-and-see approach," says Dr Joe Sniezek of the CDC's National Centre on Birth Defects and Developmental Disabilities. "While in a few instances that can be appropriate, far more often it results in children not getting the services they need at an early age, when those services can make the biggest difference in a child's development."
Dr Lisa Wiggins, developmental psychologist and epidemiologist at the CDC, says: "Children with ASD can be reliably diagnosed at age two, although many children are not diagnosed until age four or older."
Michael Rosanoff, director of public health research for the advocacy group Autism Speaks, says many factors can contribute to the later diagnoses.
"The first is that even though the American Academy of Paediatrics recommends that all children be screened for autism twice before the age of two, it is unclear whether paediatricians are adhering to these guidelines," he says. "The second is that even though warning signs of autism can appear as early as 12 months, in some instances the signs may be subtle, and in others, especially for less severely affected children, they may not become apparent until school age."
Rosanoff also notes that screening services may not be readily available to people who have less access to health care in general. Additionally, others might face long waiting periods between parents' first concerns, screening and diagnosis.
The American Academy of Paediatrics recommends that children be screened for general development at nine, 18 and 24 or 30 months and for autism at 18 and 24 months, or whenever a parent has concerns.
Autism Speaks lists on its website the following "red flags" that might be reason for concern and should prompt a call to a paediatrician.
- No big smiles or other warm, joyful expressions by six months old.
- No back-and-forth sharing of sounds, smiles or other facial expressions by nine months old.
- No babbling by 12 months old.
- No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months old.
- No words by 16 months old.
- No meaningful, two-word phrases (not including imitating or repeating) by 24 months.
- Any loss of speech, babbling or social skills at any age.
One of the screening tools used by paediatricians is the M-CHAT-R (modified checklist for autism in toddlers, revised), devised by Drexel University's Dr Diana Robins and others. It's a list of 20 questions that can be answered with a simple yes or no and can be completed by parents in less than 10 minutes.
Three of the questions: if you point at something across the room, does the child look at it? Does your child play make believe? Is your child interested in other children?
A "no" answer on any of these could be cause for concern.
Robins says parents should trust their instincts about their children and seek out screening, evaluation or intervention if something seems amiss.
"Parents are experts on their children," she says. "If they are worried, and the paediatrician doesn't support them and make referrals, they may want a second opinion."