Autism has no one known cause and no known cure, but early detection of autism signs can lead to an early diagnosis.  Early diagnosis is crucial in obtaining early intervention and treatment.  Early intervention and treatment, in turn, can have a profoundly positive effect on the outcome of a child who has been diagnosed with autism.

So what should parents look for?  Autism affects communication and social interaction.  While delays in these areas are not the only signs of autism, they are hallmarks of the disorder. Very early signs of autism may include a baby’s failure to turn toward the source of sound or to be interested in looking at faces.  Normally developing babies love to gaze at faces and will usually smile back at a smiling face around age 4 months.

A lack of joy in interacting with parents and caregivers, or failure to babble and coo when pleased, or cry when displeased, are early signs of autism.

Around 9 months, normally developing babies will make faces and sounds in reaction to those parents or caregivers make.  If you baby is not interacting with you in this way, his failure to do so may be a sign of autism.

Most babies enjoy social games like peek-a-boo when they are around a year old, and they will use gestures to get your attention and make sounds to indicate that their needs are not being met.  If you take away a favorite plaything and your baby does not verbally protest, he may have a delay in communication skills related to autism.  If your baby does not look at you when you call him by name, he may be exhibiting a sign of autism.

By about 15 months, normally developing babies will use a few words, such as mama or dada or bye-bye.  If your baby is not doing this, you may have cause to be concerned about his language development.

Baby’s use of language develops into using a gesture-and-verbalization combination to get what baby wants around age 18 months.  Normally developing babies use about 10 words and start to engage in “pretend” games by this age as well.

If you baby is not understanding and using about 50 words by age 2, and using these words together in a telegraphic way (e. g. “more milk” or “want ball”), then this language delay may be a symptom of autism.

By age 3, the age by which most instances of autism are diagnosed, normally developing children will engage in more elaborate make-believe play, pretending to be various “actors” in scenarios and will start putting words together in ways that make sense.

Regardless of a child’s age, if he or she experiences a dramatic loss of skills he or she once had, you should be concerned that this loss of ability may be a sign of autism.

Certainly these items are not a comprehensive guide to autism symptoms, but they are hallmarks of normal development and what you should consider “red flags” of autism.  If you sense that something just isn’t right about the way your child expresses herself, or if your child seems to lose skills he once had, then consult your pediatrician right away.  Be prepared to provide specific examples of behaviors and to ask for a routine developmental screening.  The more you know about autism and its symptoms, the better prepared you will be to obtain crucial early intervention and treatment for your child.

Autism Spectrum Disorder, or ASD, is the term we usually hear when we read about autism.  As the term “spectrum” implies, there are degrees to which individuals are affected by autism, and the term ASD is used to encompass a range of severity of symptoms.  Two children may share the same diagnosis, but they may exhibit different degrees of behavioral symptoms.

How does Autism Affect Children?

Most useful for parents, though, is not so much what terminology is used to describe autism, but rather how the disorder manifests itself and affects those who have this complex neuro-biological impairment.  As the Autism Society of America reports, “Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities.”

Children on the autism spectrum have difficulty interacting with or playing with others.  These difficulties include avoiding eye contact or being averse to being held or touched.  Delays in development of physical, cognitive, social and emotional skills and language acquisition and use (or the achievement and then loss of developmental skills) are also hallmarks of autism.

What Causes Autism?

Although research is ongoing, there is currently no consensus as to the cause of autism.  Genetics and environmental factors may play a role in the development of the disorder, but research has not established any definitive links.

There has been much speculation about whether thimerosal (mercury)-containing vaccines can cause autism.  No research has found a link between vaccines and autism, and nearly all vaccines have been thimerosal-free since 2001.  Researchers do know that parenting styles are not a factor in whether a child is affected by autism.

References and Additional Resources:

Physical Development

A child’s physical growth is easy to measure with simple tools; his or her physical development requires observation by parents, caregivers, and health care practitioners.  Physical development encompasses many things depending on the child’s age: rolling from back to front and front to back, holding one’s head up, sitting alone, standing with or without support, crawling, walking, climbing stairs, throwing a ball, and imitating scribbling are all examples of a child’s physical development.

Cognitive Development

Cognitive development also encompasses a variety of skills and abilities.  Whether a child will search for an object hidden while he is looking, or while he is not looking, is a measurement of cognitive development.  A child’s problem-solving skills (does she move a stool to the counter in order to reach an object?) and ability to understand concepts such as “two” are examples of how cognitive development is measured.

Social and Emotional

A child’s social and emotional development is vital. Expressing joy or displeasure, being able to understand when another’s facial expressions or tone of voice indicate joy or displeasure, smiling, laughing, waving, and maintaining eye contact are all measurements of social and emotional development. For older children, the ability to play cooperatively and collaboratively and to take turns are other developmental milestones.  Playing make-believe games is another example of emotional and social development.

Language

Babies are hard-wired for language, and, if developing appropriately, will coo and make other noises from birth. Around one year, normally developing children can use a word or two; by age two, short subject + verb sentences and repeating words are signs of normal development.  The extent to which a child uses language to express him- or herself as appropriate for his or her age is measured in language development assessments.

These definitions should serve as a starting point for understanding what is measured in developmental assessments. Your child’s health care practitioner can offer more detailed explanations of both what each term refers to and where you child should be developmentally at his or her age.

Approaching your pediatrician with concerns about your child’s development or your concern about whether your child could be autistic should not be any different.

If your pediatrician has told you not to worry about your autism-related concerns, then follow up with research of your own.  Find developmental checklists to see whether your child is meeting the milestones for his or her age.  If your pediatrician has not performed a routine developmental screening, then ask for one.  Monitor your child’s behavior at home to determine whether you can detect any specific developmental delays.

Once you have determined these specifics, ask for a follow-up appointment in which you can bring these concerns to your pediatrician’s attention.  The more specific detail you have, the better.  Your pediatrician sees your child far less frequently than you do, so you’re the expert here.

While pediatricians can assess a child’s development, an autism diagnosis is made only after much more in-depth assessment by a specialist.  If you are concerned that your pediatrician may be missing some of the signs about which you are concerned, ask for a referral to a specialist who can perform more in-depth testing.

You may feel uncomfortable questioning your child’s physician, but remember that you are the expert on your child and his or her behavior.  You are your child’s strongest advocate, so if you know that “don’t worry” isn’t working for you, then don’t be afraid to push for additional testing, referrals, or a second opinion regarding your concerns.  Early intervention makes a tremendous difference in the lives of children with autism.  Without early diagnosis, however, early intervention cannot start.

Physical

Children at this age continue to develop muscles and motor skills, both large and fine.  While at age 48 months, a normally developing child can stand on one foot for up to 5 seconds, that length of time increases to 10 seconds by 60 months.  The ability to hop well develops during this time, and children progress from going up and down stairs without support to going up and down stairs using alternate feet.  Fine motor skills like copying shapes and being able to print some letters progress, and by age 60 months most children can draw a person with a body.  Children learn to use silverware at the table during this time, and, by 60 months, usually can tend to their own bathroom and dressing and undressing needs.

Cognitive

Cognitive development during this stage includes moving from being able to correctly name some colors to being able to name at least four.  An increased sense of time develops as well, and fantasy and make-believe play continue and become more elaborate.  Children also develop a sense of what everyday objects are and how they are used, and, by the end of 60 months, can count 10 or more objects.

Social and Emotional

Children begin to be able to distinguish between fantasy and reality during this time, and begin to view themselves as whole beings.  As such beings, their desire to be around and to please friends develops.  By the end of 60 months, children are more likely than before to agree to rules as they become more independent.  By the end of 60 months children are aware of gender.  While increasingly cooperative, children will still sometimes be demanding during this stage as they become more independent.

Language

Language use is refined during this stage of development.  Most children can be easily understood by strangers by around age 48 months, but their sentences may be short and basic grammar rules like verb tense incorrect.  By the end of age 60 months, most children speak in sentences longer than 5 sentences (although many do before this age) and they can tell longer stories than at age 48 months.  They begin to use future tense, can say their name and address, and can recall parts of stories.

Obviously, no two children will develop at the same rate and may develop certain skills while seeming to lag in other areas.  Developmental milestones are guidelines to normal development.  Check with your pediatrician if you have any questions or concerns about the rate at which your child is developing.

Since a large component of autism is difficulty in communication and expression, a lack in these areas may be a sign that your baby has an autism spectrum disorder (ASD).  While diagnosis is complex, and not all delays are indicative of an ASD, if you find your answers to the following questions are “no,” then bring your concerns to your pediatrician right away.

Age 4 months:

Does baby react to movement and bright colors?  Does he turn toward sounds?  Are faces interesting to your baby?  Does she smile back at you?

Age 6 months:

Does your baby show joy and smile often when playing with you?  Does he babble and coo when happy, but cry when unhappy?

Age 9 Months:

Does your baby make faces and sounds with you in reaction to those you make?  Does she make gestures that mirror yours (e.g. giving and taking)?

Age 12 Months:

Does your baby use a few gestures (such as reaching, waving, pointing) one after the other in order to get his needs met? Does baby play social games such as peek-a-boo?  Does she turn to the speaker of her name?  Does baby make sounds like “ba,” “na,” “ga,” and “da”?

Age 15 Months:

Does your baby use different sounds to draw attention to things of interest and to get his needs met?  Does baby point or use other gestures to show something she’s interested in?  Does he use at least 3 words (like “bye-bye,” “mama,” “dada”)?

Age 18 Months:

Does your baby combine gestures and words to get what he or she wants?  Does she understand and use at least 10 words?  Does he engage in simple make-believe games like feeding a doll?

Age 24 Months:

Does your toddler use and understand at least 50 words and use at least two together (like “more milk”)? Does she seem to enjoy being with other children of the same age?  Does he play pretend games that involve more than one action, such as pretending to eat and then pretending to wash the dish?

Age 36 Months:

Does your child enjoy pretend play that involves talking for different characters, like dolls or action figures?  Does he answer questions that start with “what?” “who?” or “where?” easily?  Does she speak about thoughts and actions together in ways that make sense? (Such as, “Tired, go to bed”?

This list is certainly not a comprehensive checklist for developmental delays or for signs of autism, but rather a good starting point for knowing what should concern you most about your child’s emotional and language development.

Whatever the case, it is easy to pass off this worry as simply a normal part of parenting.  It is easy to rationalize worry (“It’s just a stage.” “She’ll grow out of it.).  However, trusting oneself to know one’s child is key here: if you have a concern, discuss it with your pediatrician. Parents must trust themselves with their concerns, listen to that voice of worry, get information, and take action.

Pediatricians are not with a child daily as parents are.  Parents, then, are the first line of defense in determining whether a child may have developmental delays.  Pediatricians rely on parents to relate information about the child’s development, through routine questionnaires and in answers to questions at an office visit.

If you have concerns about your child’s development, arrange an appointment for a routine developmental screening.  Find and read credible research on autism signs and symptoms.  Take note of your child’s behavior at home since those behaviors may not be repeated in an office setting.

Parents should remember that, while no one cause of autism has been discovered, it is not caused by parenting techniques.  Just as a parent would not hesitate to bring to the pediatrician’s attention a skin rash that may or may not be something more serious, so should the parent be willing to discuss developmental concerns.

Above all, if you are concerned, act quickly. There are no medical tests to rule out autism, but any concerns you have may be cause for further testing and diagnosis.  Early intervention is so important in a positive outcome for autistic children that the earlier a diagnosis can be made, the better.

As with any other concern you may have about your child, knowledge is power.  Rather than worrying, take action, and discuss your concerns with your pediatrician right away.

Physical

At age 2, normally developing children walk alone, can pull a toy behind them while walking, and carry toys while walking.  This independent walking develops into the ability to climb unassisted and then into the ability to climb by age 3.  Walking develops into running and being able to bend over without falling.  Fine motor skills move from scribbling on one’s own to being able to make circular, side-to-side, and up-and-down, more deliberate, marks with a crayon, and being able to hold a pencil in a writing position. The height of block towers increases, and children move from being able to turn over a container to dump out its contents to being able to unscrew lids and turn rotating handles.

Cognitive

Make-believe play takes off during this year.  Normally developing children begin to play “pretend” around 24 months; this develops into playing make-believe games with dolls and stuffed animals.  During this stage children move from being able to find hidden objects to being able to sort them by shape or color, and matching items.  Concepts such as the idea of “two” are developing, as is the ability to work simple, 3 or 4 piece puzzles.

Social and Emotional

Around age 2, children may begin to show defiant behavior as they are becoming aware of themselves as independent beings.  At the same time, they get excited about the company of others, and separation anxiety increases, and then fades.  The concept of “mine” and of taking turns in games starts to develop and children start to display affection for familiar friends as well as to express a range of emotions.  These displays may make parents realize their child is turning into a “real” little person, and it is this social and emotional development that can be in turn frustrating and exhilarating to witness.  Children may become increasingly less flexible, objecting to major changes in routine as they become more independent and aware of likes and dislikes.

Language

Language development during this time is rapid as well.  Around age 2, children use telegraphic language:  simple phrases and 2-to-4 word sentences, repeating words they overhear and recognizing familiar names and objects.  The ability to follow simple instructions develops into being able to follow a 2-or 3-part command and an understanding of most sentences.  Pronoun use develops, and by the end of age 3, children can state their name, age, and sex.  Strangers can usually understand most of a child’s words by age 3.

No two children develop alike, and they may seem to lag in one area of development only to catch up later.  Developmental guidelines help to assess a major deviation from normal development, so if you have any concerns about your child’s development, check with your pediatrician.

The findings of this study, conducted by researchers at the University of California, San Diego (UCSD) School of Medicine and Children’s Hospital and Health Center, is meaningful in terms of earlier diagnosis that can lead to earlier intervention and therefore to improved outcomes for children diagnosed with autism.

Autism is usually diagnosed by age 3; diagnosis is made base on observation of behavior, not a medical test. The earlier the diagnosis is made, the earlier treatment can begin.  The early warning sign of increased brain growth occurs before behavioral symptoms of autism are noted.

Researchers in the UCSD study found that the rapid brain growth in children with autism means that “when the brain is experiencing the world and deciding how to construct itself, it’s growing too fast in the infant with autism,” according to the study’s senior author Eric Courchesne, Ph.D. In short, the brain cannot keep up with experiences and information and this makes “it very hard for autistic children to make sense of the world they live in,“ says Courchesne.

The more excessive the brain growth, the more severe autism is, according to study results.

Researchers studied medical records of 48 children aged 2 to 5 who have an autism diagnosis; head circumferences were compared to the Centers for Disease Control and Prevention’s growth charts for normal development.  The findings were that, on average, the head circumference of autistic children at birth was smaller than about 75 percent of other newborns.  However, in the first year, these children had a rapid growth in brain size, reaching the 85th percentile (only 15 % of other newborns had a smaller head size) at around 1 year to 14 months old.  Then, brain growth slowed.

Courchesne explains:  “This burst of overgrowth takes place in a brief period of time, between about two months and six to 14 months of age. So, we know it cannot be caused by events that occur later, such as vaccinations for mumps, measles and rubella or exposure to toxins during childhood.”

This study, according to Courchesne, “provides, for the first time, a developmental process to target for animal model studies of the disorder. Animal models that accurately mimic these abnormal growth events will be necessary in order to discover causes and biological treatments for autism. Once we know what causes this specific growth defect, it may be possible to use biological treatments to successfully intervene before the overgrowth begins, thereby allowing the brain and behavior to develop down more normal paths.”

While certain other conditions such as hydrocephalus or certain metabolic disorders can cause a large head circumference, they are much less common than autism.

Research has found that experience-guided growth is beneficial to human brain development.  Experiences that pass through certain pathways in the brain lead to higher order neurobehavioral functions and skills, such as motor skills, linguistic, emotional, and cognitive skills.

The findings of this study have positive implications for treatment. Courchesne states, “Using our findings as an early indicator of autism, intervention might begin two or three years earlier when the brain might be at a more malleable stage and so, might result in a better outcome for the child.”

While all it takes to measure head circumference and, consequently, brain size, is a tape measure, not all pediatricians include this in routine visits.  The research team advocates routine head circumference measures in the first year of life.