Abnormalities in social behaviour and attention are present for months and even years before a diagnosis of autism is made. As it is often the case that the parents are the first to notice that something is wrong, it is critical that all parents:
1) are aware of the early signs of autism and
2) persist in seeking help if they believe there is a problem.
Identifying autism as early as possible is important because of the benefits of early intervention. The earlier children get help, the more potential they have for improving their social and communication skills.
Many parents of autistic children notice abnormalities early on, and parental concerns at 12 months of age do predict later diagnoses. One study found that nearly 80% of parents with autistic children had concerns before the child turned 2, much earlier than the time of diagnosis. The earliest concerns parents had were regarding behaviours not necessarily related to the diagnostic criteria for autism. These concerns included motor problems, sensory reactivity, lack of attention, difficulty regulating emotions, and sleep problems.
These findings suggest that parental concerns need to be taken more seriously. A parent knows their child better than anyone else, and is in the best place for spotting abnormalities. As autism is a disorder characterised by problems with social communication, parents are likely to be the first to notice. They may not be able to specify exactly what the problem is, or where their child is falling behind, but they can just sense that something isn’t right. They know their child isn’t connecting with them the way they should.
Unfortunately, parents often aren’t taken seriously by health professionals, perhaps because these initial concerns are not the classic signs of autism. Sometimes the parents who are first to seek help, are the last to receive a diagnosis. If parents are turned away by health professionals early on, they will likely be more reluctant to return when further concerns develop, ultimately resulting in delayed diagnosis.
To remedy this issue:
1) Health care professionals who are the first contact for parents (general practitioners, paediatricians, etc) need to be aware of the earliest signs of autism and to take parental concerns seriously (for example, more referrals to specialists)
2) Parents need to be aware of the earliest signs of autism and to be confident in their own judgment. If concerns are not dealt with to their satisfaction, it may require a second (or third) opinion from a different health professional. If you think there is a problem, trust your instincts!
What Are the Earliest Signs of Autism?
Autism is rarely diagnosed before the age of 3, likely due to the central role of delayed verbal communication in making a diagnosis. But there are a number of ways that children with autism are already different from their peers at 12 months of age.
Some research has found that as early as 6 months of age, babies later diagnosed as autistic are more passive (have a lower activity level) and show less social attention (less looking, smiling, and vocalising towards people). Differences are not always seen as early as 6 months, but by 12 months there is a reliable pattern of social behaviours that predict later diagnosis of autism.
Signs of autism at 12 months (compared to other children of the same age):
•greater fixation on particular objects
•takes longer to switch attention
•frequent and intense distress reactions to stimuli
•fewer understood phrases
•poor eye contact
•reduced social smiles and social interest
•lack of imitation
What seems to be most telling is a decline in functioning. Reductions in social behaviours and increased difficulty disengaging visual attention between 6 and 12 months are key features seen in infants later diagnosed as autistic. Between 6 and 12 months, babies who begin to look less at faces, smile less at people, and make fewer vocalisations towards people (compared to their own previous levels of these behaviours) are likely to be later diagnosed as autistic. Similarly, babies who find it increasingly difficult to disengage their visual attention, compared to their own previous abilities, are more likely to be later diagnosed as autistic.
These early markers are not enough to diagnose autism, as diagnosis requires there to be problems with aspects of development – verbal communication in particular – that don’t develop until children are older. However, the earlier parents seek help the more beneficial it will be for the child, and the process of diagnosis can be initiated.
If you have any concerns about your child, please contact your family doctor or paediatrician for an evaluation.
For more information and resources on autism, check out: