What is Autism?

Autism has a wide spectrum of symptoms. Autism Spectrum Disorder (ASD) appears in infancy and early childhood, that can cause delays in many basic areas of development, such as learning to talk, play and interact with others.

The signs and symptoms of autism can vary widely, as do the effects thereof. Some children may only have mild impairments, while others may have more obstacles to overcome. But all children on the spectrum has problems to some degree in the following areas:
• Communicating verbally and non-verbally
• Relating to others and the world around them
• Thinking and behaving flexibly

Opinions differ among doctors, parents and experts on what causes autism and how best to treat it. There is one fact that everyone does agree on, early and intensive intervention helps. For children at risk and children who show early signs, it can make all the difference. But it does not matter your child’s age, treatment can reduce the disorder’s effect and help your child thrive in life.

What is High-Functioning Autism?

High-Functioning implies that someone with autism has the intellectual ability to navigate society without assistance. It is often used to describe people with Asperger’s Syndrome, which was initially categorized as a separate and milder disorder than autism. A child that has been diagnosed with Aspergers might not experience the same speech delays as a child diagnosed with autism. However Asperger is now officially incorporated into the broader autism spectrum, you might sometimes still hear this term used.

In an early study, researchers argued that the term “high-functioning” could be both harmful and misleading. It puts heavy emphasis on IQ and does not account for all the potential strengths and weaknesses an autistic individual may have. And just because someone has an average or high IQ, it does not mean that they can adapt or function well in other ways.

How Parents Can Spot the Warning Signs

A parent is in the best position to spot the earlier signs of autism. You know your child the best and observe behaviours and quirks that a paediatrician in a fifteen minute visit may not even have a chance to see. Do not discount the importance of your own observations and experience. The key is to educate yourself so you are aware of what is typical and what is not.

Monitor your child’s development. Autism involves a variety of development delays, so keeping a close eye on if your child is hitting the key social, emotional and cognitive milestones is an effective way to spot a problem early on. Keep in mind, development delays do not automatically point to autism, but may indicate a heightened risk.

Take action if you are concerned. All children develop at a different pace, so you should not panic if your child is a little late to talk or walk. When it comes to healthy development, there is a wide range of “typical”. But if your child is not meeting milestones for his or her age, or you suspect a problem, share your concerns with your doctor or psychiatrist immediately.

Don’t accept a wait-and-see approach. Concerned parents are generally told not to worry or wait and see. But waiting can be the worst thing to do. You risk losing valuable time at an age where your child has the best chance for improvement. Whether the delay is caused by autism or another factor, developmentally delayed children are unlikely to simply “grow out of” their problems. In order to develop skills in an area of delay, your child will need extra support and targeted treatment.

Trust your instinct. In an ideal world, your doctor will take your concerns seriously and perform a thorough evaluation for autism or any other development delays. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Listen to your gut if it is telling you something is wrong and be persistent. Schedule a follow-up appointment with the doctor, seek a second opinion or ask for a referral to a child development specialist.

Regression of Any Kind is a Serious Autism Warning Sign

Some children on the spectrum start to develop communication skills then regress, this usually happens between 12 and 24 months. For example, a child who was communicating with words such as “mommy” or “up” may stop using language entirely, or they may stop playing social games they used to enjoy such as peek-a-boo or waving “bye-bye”. Any loss of speech, babbling, gestures or social skills should be taken very seriously, as regression is a major red flag for autism.

Signs and Symptoms of Autism in Babies and Toddlers

If autism is caught in infancy, treatment can be taken in full advantage of the young brain’s remarkable plasticity. Although autism is hard to diagnose before 24 months, symptoms often surface between 12-18 months. If signs are detected by 18 months, treatment may help to rewire the brain and reverse the symptoms.

The earliest sign of autism involve the absence of typical behaviours, not the presence of atypical ones, so they can be hard to spot. The earliest symptom can be misinterpreted as signs of a “good baby”, since the infant may seem quiet, independent and undemanding. Some autistic infants do not respond to cuddling, reach out to be picked up or look at their mothers when being fed.

Early Signs

Your baby or toddles doesn’t:
• Make eye contact such as looking at you when being fed or smiling when being smiled at.
• Respond to their name or the sound of a familiar voice
• Follow objects visually of your gesture when you point things out
• Point or wave goodbye, or use other gestures to communicate
• Make noises to get your attention
• Initiate or respond to cuddling or reach out to be picked up
• Imitate your movements and facial expressions
• Play with others or chare interest and enjoyment
• Notice or care if you hurt yourself or experience discomfort

Developmental Red Flags

The following delays warrant an immediate evaluation by your child’s paediatrician:
• By 6 months: No big smiles or other warm, joyful expressions
• By 9 months: No back-and-forth sharing of sounds, smiles or other facial expressions
• By 12 months: Lack of response to name. No babbling or “baby talk”. No back-and-forth gestures such as pointing, showing, reaching or waving
• By 16 months: No spoken words
• By 24 months: No meaningful two-word phrases that don’t involve imitating or repeating.

Signs and Symptoms in Older Children

As children get older, the red flags for autism become more diverse. They typically revolve around impaired social skills, speech and language difficulties, non-verbal communication and inflexible behaviour.

Signs of Social Difficulties

• Appears disinterested or unaware of other people or what is going on around them
• Does not know how to connect with others, play or make friends
• Prefers not to be touched, held or cuddled
• Does not play “pretend” games, engage in group games, imitate others or use toys in creative ways
• Has trouble understanding feelings or talking about them
• Does not seem to hear when others talk to them

Basic social interactions can be difficult for children with autism spectrum disorder. Many children on the spectrum seem to prefer to live in their own world, aloof and detached from others.

• Speaks in an atypical tone of voice or with an odd rhythm or pitch (eg ends every sentence as if asking a question)
• Repeats the same words or phrases over and over, often without communicative intent
• Responds to a question by repeating it, rather than answering it
• Uses language incorrectly (grammatical errors, wrong words) or refers to him or herself in the third person
• Has difficulty communicating needs or desires
• Does not understand simple directions, statements or questions
• Takes what is said too literally (misses undertones of humor, irony or sarcasm)

Children with autism have difficulty with speech and language. They often start talking late.

Signs of Nonverbal Communication Difficulties

• Avoids eye contact
• Uses facial expressions that do not match what they are saying
• Does not pick up on other people’s facial expressions, tone of voice and gestures
• Makes very few gestures (such as pointing). May come across as cold or “robot-like”
• Reacts unusually to sights, smells, textures and sounds. May be especially sensitive to loud noises. Can also be unresponsive to people enterling/leaving as well as efforts by others to attract the child’s attention
• Atypical posture, clumsiness, or eccentric ways of moving (eg waling exclusively on tiptoe)

Autistic children have trouble picking up on subtle nonverbal cues and using body language. This makes the “give-and-take” of social interaction very difficult.

Signs of Inflexibility

• Follows a set routine (eg insists on taking a specific route to school)
• Has difficulty adapting to any changes in schedule or environment (eg throws a tantrum if the furniture is rearranged or bedtime is at a different time than usual)
• Unusual attachments to toys or strange objects such as keys, light switches, or rubber bands. Obsessively lines things up or arranges them in a certain order
• Preoccupation with a narrow topic of interest, often involving numbers or symbols (eg, memorizing and reciting facts about maps, train schedules or sports statistics)
• Spends long periods watching moving objects such as a ceiling fan, or focusing on one specific part of an object such as the wheels of a toy car
• Repeats the same actions or movements over and over again, such as flapping hands, rocking, or twirling (known as self-stimulatory behaviour). Some researchers and clinicians believe these behaviours may soothe children more than stimulate them.

Children with autism spectrum disorder are often restricted, inflexible and even obsessive in their behaviours, activities and interests.

Common Restrictive and repetitive behaviours:
• Hand flapping
• Rocking back and forth
• Spinning in a circle
• Finger licking
• Head banging
• Staring at lights
• Moving fingers in front of the eyes
• Snapping fingers
• Tapping ears
• Scratching
• Lining up toys
• Spinning objects
• Wheel spinning
• Watching moving objects
• Flicking light switches on and off
• Repeating words or noises