Early Features of Autism
by Dr Avril Brereton
Parents of children with autism often report difficulties or delays
in their child’s early development prior to two years of age, yet
diagnosis is often not made until a child is about four years of age
or older. Placement in early intervention programmes before four
years of age is thought to improve outcome for children with autism.
Those children who receive a diagnosis of autism after four years of
age may be missing the opportunity for early intervention.
In recent years a number of studies
have sought to describe the early features of autism in infants and
preschool children. Some studies have interviewed parents to
establish what problems initially cause them the most concern,
others have observed children in controlled play and assessment
situations.
The early features of autism
identified in these studies are listed below (Gray & Tonge, 2001).
1. Social interaction
-
Poor social interaction
-
Lack of interest in other children
-
Lack of seeking to share own enjoyment
-
Failure to develop peer relations
-
Failure to join in activities of others
-
Failure to direct adult’s attention to own activity
-
Does not direct the attention of others
-
Does not hold up arms to be lifted up
-
Does not show affection
-
Does not seek or offer comfort
-
Dislikes social touch and being held
-
Lack of social responsiveness
-
Ignores people
-
Lack of social play
-
Being in own world
-
Prefers being alone
-
Indifferent to others
-
Does not differentiate between people
-
Lack of attention to voices
-
No social smile
-
Lack of eye contact
-
Lack of gesture
-
Lack of facial expression
-
No greeting behaviours
2. Communication
-
Lack of verbal communication
-
No social chat
-
Lack/limited range of facial expression
-
No/abnormal eye contact
-
No or “empty” smiling
-
Loss of previously acquired words
-
Problems with language comprehension
-
Does not express emotion
-
Poor imitation
-
Use of other’s body as a tool
-
Lack of infant babble
-
Echolalia
-
No gaze monitoring
-
No pointing to express interest
-
No use or understanding of gestures
The features listed under the
categories of Stereotyped and repetitive routines, behaviours and
interests (3), Play and Sensory (4) and Other behaviours (5) are not
necessarily present in very young children. This may be because
there is a developmental process in the emergence of these autism
symptoms.
3. Stereotyped and repetitive
routines, behaviours and interests
-
Verbal rituals
-
Hand and finger mannerisms
-
Whole body mannerisms
-
Unusual/repetitive preoccupations
-
Unusual/repetitive attachment to objects
4. Play and sensory
-
Lack of spontaneous play
-
Lack of imitative play
-
No pretend play
-
Sensitivity to noise
-
Insensitivity to pain/cold
-
Unusual sensory interests
-
Deafness suspected
-
Mouthing of objects
-
Unusual looking at objects/patterns/movements
5. Other behaviours
Some of the features listed above are
also present in young children with developmental delay. Therefore,
studies that have compared the behaviour of young children with
autism with those who have developmental delay without autism
provide the best information on the features and symptoms of autism
in infants and preschool children.
The absence of stereotyped and
repetitive behaviour in very young children does not exclude the
possibility of autism. The presence of obsessional behaviour may be
dependent upon more advanced language and cognitive skills and
emerge later as the child makes developmental gains. Deficits in
basic communication and social skills are apparent in the first two
years of life in young children with autism (Gray & Tonge, 2001;
Zwaigenbaum, 2001).
Differentiating between speech delay,
developmental delay and autism in young children.
Parents of young children with autism
often report delayed speech as their first concern, but speech delay
is not specific to autism. Delayed speech is also present in young
children with global developmental delay caused by intellectual
disability and those with severe to profound hearing loss. Children
with speech delays or hearing loss are usually able to compensate
for their limited or lack of speech by the use of non verbal
communication skills such as using gestures (e.g. pointing), eye
contact and facial expression to get their message across. These
children also respond to praise, can empathise, imitate and engage
in make believe play. Children with developmental delay will also
usually attain these skills when their developmental level passes
about 12 months of age. However, the child with autism continues to
have ongoing problems with delayed and disordered language, social
communication skills, empathy and pretend play skills regardless of
developmental level (Charman & Baird, 2002). These findings have
implications for early screening and diagnosis in very young
children.
-
The diagnostic features of
insistence on sameness, distress over change in
routines, adherence to rituals and routines, abnormal
comfort seeking and unusual attachment to objects that
are typically present in older children are often not
present in preschool children.
-
The range of communication
problems present in older children, such as impaired
conversational skills and problems with speech
production are not typically present in younger children
who are yet to acquire speech.
- Assessment of very young
children needs to take the absence of some autism
symptoms into account. Some researchers have suggested
that standard diagnostic criteria should be modified for
children under two to take into account the presentation
of autism in infants and preschoolers.
Early identification of autism
is clearly important but is not an end in itself. How we respond to
very young children with autism and their families is critical.
Early identification is only useful if followed up by access to
early intervention programmes, parent education and support and a
range of health, education and welfare services for the child and
his/her family.
What to look for in the first year of
life:
-
Lack of social smile
-
Lack of appropriate facial expression
-
Poor attention
-
Aversion to being touched
-
Not responsive to name
-
Unusual looking at objects/patterns/movements
What additional things to look for in
the two year old:
-
Ignoring people
-
Preference for aloneness
-
Lack of or impaired eye contact
-
Lack of gestures (e.g. pointing to objects)
-
Lack of emotional expression
- Lack of age appropriate play with toys
References
Charman, T & Baird, G. (2002).
Practitioner Review: Diagnosis of autism spectrum disorder in 2- and
3- year old children. J. Psychology and Psychiatry, 43,
289-305.
Gray, K & Tonge, B. (2001). Review
article. Are there early features of autism in infants and preschool
children? J. Paediatr. Child Health, 37, 221-226.
Zwaigenbaum, L. (2001). Autistic
spectrum disorders in preschool children. Canadian Family
Physician, 47, 2037-2042.
. |
