The first signs of autism usually appear as developmental delays before the age of three. If you suspect your child may be autistic, it is important to seek a diagnosis as soon as possible. Early intervention for autism gives a child the best chance to reach her full potential.
The ‘hidden’ disability
Autism is often referred to as the ‘hidden’ disability because people who are on the autistic spectrum show no significant physical difference to their peers. Rather it is their behaviours that mark them out as different.
The three main areas of difficulty for people with autism are referred to as the ‘triad of impairments’:
- Social communication
- Social interaction
- Social imagination
Although not included in the triad of impairments, there is a fourth area, which has been identified as presenting people with autism with significant difficulties and that is the area of sensory processing. Sensory processing difficulties are indicated by either a hyper or hyposensitivity across any or all of the five senses.
The first signs of autism usually appear as developmental delays before the age of three. Autism is described as a ‘spectrum’ disorder. This means that the symptoms and characteristics of autism can present themselves in a wide variety of combinations and can range from mild to severe. Two children with the same diagnosis can act very differently from one another and have varying skills.
What causes autism spectrum disorder?
We don’t know exactly what causes ASD. But the latest research shows that in children with ASD:
- There’s early brain overgrowth, which means the brain grows faster than average.
- Different parts of the brain don’t communicate with each other in a typical way.
- Evidence also strongly suggests a genetic basis to ASD – that is, the condition might come from the complex interaction of several genes involved in brain development.
Where do I go if I think my child may have autism?
Frequently, parents don’t suspect a problem with the development of their child until 18 months to two years or older. Initially, if your child is still being seen by the Child Development Team at your local Health Centre, you should express your concerns to them and ask for a referral to a Developmental Paediatrician. If your child is older, you can go to your GP and ask for the same referral.
If deemed necessary, you may firstly be referred to a hearing specialist to rule out other developmental delays associated with language and communication disorders including deafness. If your child is older still and at school, you need to ask the School Principal to arrange for the child to be assessed by an educational psychologist.
How early can a child be diagnosed?
Autism Spectrum Disorder is generally diagnosed from the age of 2½ years. This is because some of the skills or emerging skills that the assessment team are looking for would not be apparent in a typically developing child younger than this.
According to Irish Autism Action, parents often report being concerned about lack of emerging skills in their children at a younger age. If this is the case, there is the Checklist for Autism in Toddlers (CHAT) tool that you can use with your primary healthcare worker to indicate if you need to be concerned about the possibility that you child may have a social-communication disorder.
Early signs of autism spectrum disorder
Some early signs of autism spectrum disorder (ASD) – usually seen in the first two years – are listed below.
Some children will have many of these early warning signs, whereas others might have only a few. Some behaviour signs can change over time, or become clearer as the child gets older. Also, any loss of social or language skills during this period is cause for concern.
The number of signs in each category varies according to the age of the child and how severely the child is affected.
Katie Cremin, Associate Professor in Occupational Therapy, Trinity College Dublin and board member at Sensational Kids Charity, Kildare provides some expert advice.
Seek the advice of a professional
About one in every 100 people is believed to have an autistic spectrum disorder (ASD), with boys outnumbering girls. With these high prevalence rates and a concern that rates may be rising, it is a good idea to be vigilant for signs in your child. Early diagnosis and intervention is known to be the most effective way of lessening the severity of the disorder. Alongside ASD there are several other ‘neurodevelopmental’ disorders of varying severity and presentations, which can have similar signs to ASD in a child.
If you have any concerns at all, seek the advice of a professional early on. Watching and worrying about a child, but not seeking help is very stressful. Many children will have unusual quirks, sensitivities and ways of behaving that may be considered not typical or unusual – this does not make them autistic. Also within the diagnosis of ASD there is a multitude of presentations, levels of severity and ways in which the child may be affected.
Having a diagnosis of ASD does not define the child. Every child has his or her own unique developmental pathway and ways of learning; a label does not change this. It is difficult to give short and concise red flag markers for a child – but looking at the diagnostic criteria for ASD and highlighting some observable behaviours may be useful for parents who are concerned.
In a nutshell, the individual with ASD has persistent deficits in social communication and social interaction across all aspects of their lives, in combination with restricted patterns of behaviour, interests or activities. The deficits need to be severe enough to be impacting on their day-to-day life in a significant manner and also present in their early development.
Possible signs of autism – Red flags to watch out for
For a young child or toddler red flags may include some of the following:
- Limited smiles and reciprocal smiling from six months.
- Limited sharing of sounds from nine months.
- Limited babbling from 12 months.
- Lack of speech from two years.
- Toddler who appears like they may be deaf or hard of hearing, i.e. doesn’t respond to their name or verbal interactions.
- Toddler with limited interest or ability to interact.
- Young child who is not making eye contact or watching for your facial reactions.
- Young child with limited pointing to show interest in things and capture adult attention.
- Toddler or young child with obsessional interest in things, e.g. TV programmes, characters, etc.
- Toddler or young child who lines up toys and doesn’t seem to be developing imaginary or make-believe play.
- Toddler or young child with unusual patterns of movement such as spinning, hand flapping/flicking or toe walking.
- Toddler or young child who is highly under or over active in their movements.
Many children present with aspects or behaviours from this list who do not have ASD, so try not to make presumptions or become overly concerned about your child before you get professional help.
If you have any concerns about your child’s development it is important to seek out help. Any child born after June 1st 2002 is eligible to apply for an assessment of need under the Disability Act 2005, regardless of their age at the time of application. You can find out about this service through your local health centre.
If you are specifically concerned about ASD, the Irish Society for Autism and Irish Autism Action provide support and information. A preliminary assessment by a qualified psychologist, occupational therapist or speech and language therapist may also be useful.
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