Understanding the Signs of Autism

From the pages of medical journals to the halls of Congress and everywhere in between, there is increased concern about the family of developmental disorders called the autistic spectrum. We don't know if there is a real increase in these disorders or just a heightened awareness of them, but autism is on a lot of parents' minds. Since early recognition can make a big difference in a child's success over the long term, it's wise to get an evaluation of a child if you're concerned.
Personality Differences

The second and third years in a child's life are generally filled with emotion, intensity, and big mood swings. Yet each child's personality is different. A quiet child, for example, takes in everything and gives a more measured response to what she observes. Her response may not be immediately apparent because it comes later than you expect or is subtly expressed. Very sensitive children may turn off for brief periods of time by ignoring everybody and everything when life gets to be too much for them.

These temperamental differences may make it difficult to tell if a child has real difficulties with social interaction and communication, the core of the autistic disorders. It also may be hard to determine whether a child's special interests or patterns of movement and play are part of his own personality or a cause for concern. Parents may wonder if their child's social reactions should be more consistent with "normal" behavior patterns. This is particularly true in the case of a very serious, solemn child.

A "What to Look For" List

The following list, which includes behaviors that are normal and those that are unusual, will help you decide whether your 18- to 36-month-old needs professional assessment.

• Does your child have good eye contact? A constant steely gaze may rattle you, but the child who consistently avoids eye contact with you and others is the one that should raise concern. Does your child look you in the eye when you or others call his name or greet him?
• Does your child "pretend play"? That is, does he play with dolls by making them part of a story? Does he use his trucks to act out an activity like a journey to a dumping site? At this age, his fascination with the wheels of the truck turning should be developing into using a moving truck in a story. If he's stuck on just turning the wheels for turning's sake, that should be looked into.

He should also be able to understand that one thing can be used as a substitute for another, as when he holds a banana to his ear and acts as though it's a phone. Play should be more than banging, mouthing, or throwing toys now.

• All children are interested in non-toys and use them as part of their imaginative play. A child with unusual play preferences who avoids more typical activity needs a look. Unusual preferences include leaning against the refrigerator to feel its hum or dragging a ripped catalog all the time. Other examples are constantly going after string and stringlike objects, being fascinated with spinning objects to the exclusion of all else, and twisting a doorknob for hours on end.
• Behaviors such as walking on her toes, twirling, spinning, or flapping her hands should be a concern if they are done all the time and not as an occasional experiment.
• A child should be able to imitate behavior around him by hugging, holding, and caring for dolls or stuffed animals. This means he's absorbing what's going on around him and wants to be a part of them. He is also engaging in representational play and social interaction with doll play. A child who doesn't do this or merely drags a doll around with him or plays with only a part of a doll such as the hair is a concern.
• Now's the time for your child to share experiences with you. Not only should your child be pointing at things that interest her but she also should be bringing them to show you. This shared interest in her environment is an expected part of a child's social development. If she isn't sharing with you, this may need a second look.
• Many children watch other children before they are ready to participate in play together. They observe what's going on. The younger toddler imitates what another child does either right away or later in what's called a delayed imitation. At age 1 or 2, a child should be noticing others and changing the way he plays in response to other children. A parent should be concerned if he's always in his own world.
• Does your child like to snuggle? Does he like the touch of those he knows? Being shy and slow to warm up are normal and can be protective behavior. Consistent aversion to touch isn't normal, however.
• Does your child respond to your facial expressions and to your moods? Children this age are sensitive to changes in the emotional climate of a parent and the family. In quiet children, that response is apt to be subtle, but it is there. An autistic child really doesn't pick up on the moods around her.
• Does your child show his emotions? If you have a quiet child, you may have to look carefully to see these shifts. If his facial expression and mood seldom change—if they're mostly neutral—this is a concern.
• Some quiet children have very little to say, but they understand what's said to them. For these children, what they do say follows developmental expectations. At this stage, your child should be showing that he's learning new words, more each day. If he's just echoing what's said to him, or if he screams or jabbers nonsense most of the time, this is a cause for concern.

Click here for more on speech development in your toddler.

Speaking Up for Your Child

All children show some atypical behavior some of the time. That's normal. What isn't normal is when a child consistently shows these atypical behaviors. Bring any concerns to your health care provider. You may receive a referral to a behavioral pediatrician or a neurologist for further evaluation.

Most families know instinctively that there is something unusual about their child in the first year of the child's life. Pay attention to those feelings. If language is delayed and play is atypical in the first year, don't hesitate to get some help, as early action will make a lot of difference.