Something about your child doesn’t seem right. Maybe he’s not babbling by 12 months or seems more interested in watching the spinning fan than playing with you. Maybe he doesn’t make eye contact or interact with others all that much at school. Should you be worried?
Autism is the fastest growing neurodevelopmental disorder in the US impacting social, communication, emotional and behavioral skills. And according to Autism New Jersey, 1 in 45 children in the state has been diagnosed with it. “This rate may be due to various factors, including more awareness and screening in New Jersey, and families moving to the state to receive services,” says Dr. Eric Hollander, director of the Autism and Obsessive Compulsive Spectrum Program at Albert Einstein College of Medicine and Montefiore Medical Center.
Since an autism spectrum disorder (ASD) diagnosis may include multiple conditions like autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS) and Asperger’s syndrome, one child with autism may have very different symptoms than another.
Typically, autistic kids display repetitive and restricted behaviors. “The earliest signs can sometimes start before one year of age,” says Michael Rosanoff, an epidemiologist and the director of public health research for Autism Speaks. “The lack of joyful expressions and eye contact can be among the earliest signs. As children get older and you expect them to become more social, the lack of language or social interaction can be red flags.”
Autism symptoms may also worsen over time, according to Lynn Koegel, PhD, clinical director of the Koegel Autism Center at the University of California, Santa Barbara and co-author of Overcoming Autism: Finding the Answers, Strategies, and Hope That Can Transform a Child’s Life.
“These infants are often more interested in items than people,” says Koegel. “They aren’t excited and smiling in response to activities like peek-a-boo that delight most infants.”
Common symptoms of autism include:
• No pointing, reaching, waving or gesturing by 12 months
• No babbling by 12 months
• No single words by 16 months
• No meaningful, spontaneous, two-word phrases (not including imitating or repeating) by 24 months
• Loss of gained language or social skills (at any age)
• Excessive difficulty transitioning and extreme reliance on routines
• Repetitive behaviors, activities and interests (for example playing with just one toy or watching the same video repeatedly)
• Not reaching out to others to share information or feelings about objects in the environment (i.e. if a helicopter is flying overhead, he won’t point and say, “Helicopter!” and look to a parent or other person for a response)
• Exhibiting unusual responses to how things feel, sound, smell, look or taste
• Not engaging in age-appropriate pretend or imitative games (such as feeding a doll)
• May not seem to notice people or may want to interact with others but doesn’t know how to talk to, play with or relate to them
• Unusual use, pitch, tone and inflection of words
• Has a complex vocabulary but poor conversational skills
• May be able to identify words or letters but is unaware of their meaning
• Repeats words or phrases excessively
• Difficulty understanding facial expressions, eye contact, body language and nonverbal cues
• Avoids eye contact and wants to be alone
Although causes of autism are unknown, some characteristics seem to be more present in autistic kids—like having an older sibling on the spectrum. “We know younger siblings of children already diagnosed with autism are at higher risk for having it,” says Rosanoff. “Some studies report a recurrence rate among siblings as high as 20 percent.”
Genetics may also contribute to the fact that more boys than girls are autistic. “Boys are four times more likely than girls to have autism,” says Rosanoff. “However, the latest science suggests that we may be missing girls with autism and may need to consider different diagnostic criteria for them.”
A study published in September by researchers at Stanford University School of Medicine found that girls with autism display fewer repetitive, restrictive behaviors than autistic boys do, though their levels of social and communication impairment are similar. These findings mean doctors may need to give less weight to restrictive behavior when diagnosing autism in girls, currently one of the three major signs in identifying autistic children, along with social and communication problems.
A few other characteristics associated with autism, according to the CDC, include:
• The child has certain rare genetic or chromosomal conditions, like fragile X syndrome or tuberous sclerosis
• The mother has taken the prescription drugs valproic (which treats certain types of seizures) or thalidomide (to treat skin lesions caused by leprosy and multiple myeloma) during pregnancy
• Being older parents
WORRIED ABOUT YOUR KID?
Pediatricians will routinely screen for autism during 18- and 24-month well visits or anytime the parents are concerned, according to the American Academy of Pediatrics (AAP). Suzanne Buchanan, a psychologist and the executive director of Autism New Jersey, suggests voicing your worries about your child assertively, especially if your doctor has a wait-and-see approach. “Parents have every right to be concerned when their children are not reaching developmental milestones,” she says.
Your pediatrician can refer you to a specialist for a more comprehensive evaluation. This check-up may include looking at your child’s behavior and development and interviewing you. It may also involve genetic and neurological testing, hearing and vision screening and other medical tests.
At the same time you’re going through that process, Buchanan suggests reaching out to New Jersey Early Intervention System (NJEIS), a statewide program for developmentally delayed kids from birth to age three. They offer a free evaluation to see if your child qualifies for intervention services. And you don’t need to wait for a doctor’s referral or a medical diagnosis to make that call.
“Early intervention has been shown to positively impact later outcomes,” says Jed Baker, PhD, the director of the Social Skills Training Project, an organization serving those with autism, and the author of Preparing for Life: The Complete Guide for Transitioning to Adulthood for Those With Autism/Asperger’s Syndrome. “The earlier you intervene to improve social and language skills, the better.”
Once your child gets an autism diagnosis, you’ll create a treatment plan based on the severity of his symptoms. Do your homework before choosing a course of treatment, keeping your son or daughter’s experiences, preferences and needs in mind, says Buchanan. Research the various treatments online or through one of the many autism organizations out there, and talk to your pediatrician to find the approach that best matches up with your child.
“Evaluate your treatment options to see which ones have been proven effective through research and which ones are a good fit,” she says.
It’s also important for parents and health care providers to work together. “Treatment works best when there’s collaboration among the whole team,” she says. “Everyone should be making decisions at the same time.”
NJ Autism Resources
• Autism Speaks: autismspeaks.org
• Autism New Jersey: autismnj.org
• ASPEN New Jersey (Asperger Autism Spectrum Education Network): aspennj.org
• You can also connect with your school district’s special needs parent group or local advocacy groups.
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