Early signs of Autism

» Autism in general

» Why is early detection important

» Early signs of autism

» Recognition algorithm

» M-Chat screening test

Autism spectrum disorder is one of the most common complex developmental disorders. According to the latest epidemiological surveys, it affects approximately 1% of children, but this number is increasing. More and more children are diagnosed with autism every day. This article will discuss the early signs of autism. Parents should pay attention to these early signs.

Autism fundamentally affects a child’s ability to create social relationships, communication, play, imagination, thinking, and behavior. A comprehensive disorder covering a broad spectrum in which the symptoms’ nature, severity, and intensity can be significantly different. In the last decade, the name autism spectrum disorder was introduced to describe the condition, indicating that the symptoms range from very severe to mild. In classic childhood autism disorder, children’s communication skills are visibly impaired; they are only minimally able to communicate with those around them, their behavior is severely repetitive, and changes are extreme and difficult to tolerate. At the other end of the spectrum, there are well-functioning autistics who, albeit unusually, create relationships with others, their use of language is specific, and their interests are different from their typically developing peers, sometimes excessively intense. The clinical picture is extremely diverse, depending on the degree of autism, other associated disorders, and the child’s mental state and personality. There is no single behavior, no single symptom that is always present, and no one that excludes the diagnosis of autism. [2] depending on the associated other disorders, the child’s mental state and personality are extremely diverse. There is no single behavior, no single symptom that is always present, and no one that excludes the diagnosis of autism. [2]

Although the symptoms develop before age 3, the diagnosis is usually only made years after the first parental signs. According to prospective research, there are no behavioral signs specific to autism during the first year of life. Still, characteristic qualitative differences already appear during the second year, so professionals experienced in autism can already establish the diagnosis around the age of 2 years. The pediatrician needs to recognize the symptoms of autism as soon as possible because this allows the child to receive care in time. It has been clearly proven that early evidence-based autism-specific interventions significantly improve the prognosis. [3] Early recognition of the condition is also very important for parents because, in connection with serious behavioral problems, they often try to help with inefficient educational methods and experience parental “incompetence.” The diagnosis enables parents to understand their child’s blockages and learn to help them with autism-specific strategies. In this way, they can significantly contribute to meeting their children’s special needs. The family needs to receive correct genetic counseling.

Reciprocity is fundamentally important in social interaction: back-and-forth interaction, cooperation, and partnership. In autism, this reciprocity is fundamentally impaired.

In severe cases, a child with autism is more interested in objects than in people. The child seems aloof, withdrawn, and indifferent. One of the most striking early symptoms is the lack of joint attention and sharing of interests. For example, if the parent tries to draw the child’s attention to something by pointing, the child does not follow the direction of the pointing; the child does not spontaneously show his parents what he likes. Your child does not take part in social games with pleasure (e.g., peek-a-boo games, cookies-cookies), and does not imitate everyday actions. Later, it is difficult to involve him in joint activities and games; he prefers solitary pursuits. He expresses his emotions little and sometimes in an unusual way; he also reacts less to the emotions of others (e.g., he does not share his joy, he flies his hands in joy; he does not notice when the other person is in trouble, does not ask for help in trouble). For the most part, they cannot use eye contact properly to regulate social interactions.

Communication differences can be very broad: from a child who does not speak at all to a child who speaks fluently with a vocabulary that exceeds his age but is difficult to engage in conversation. Most children’s speech development is delayed (except for Asperger’s syndrome), which is most often the symptom that causes parents to seek help. It happens that the child says a few words around the age of one, then abandons them, and the vocabulary grows very slowly. A child with autism does not try to make up for the lack of speech with non-verbal means; he cannot properly express his intentions (e.g., he does not use easily understandable gestures, he cannot point to the desired object, but pulls the parent’s hand when he wants to achieve something; he does not use his head indicate protest or approval) and do not even understand similar signals from their environment. He often repeats the speech he hears (echoalates), uses borrowed panels in his speech, and swaps personal pronouns. Many times his speech is not directed at a person. Rather he monologues or comments on his actions. He usually uses unusual intonation and speaks in a flat, monotone voice. In a severe condition, he does not understand speech; it seems as if he does not hear, and he does not even pay attention to your name.

Repetitive behavior and narrowed interests are common among children with autism. Narrowed interests can also prevent the child from normal activities and social interaction. Instead of the functional use of objects, he is bound by the details of objects, for example, strings, turning a car wheel, opening a door, etc. Instead of the “pretend” or “role” games expected at his age, he arranges the objects in a row, sorts them according to his own logic, and arranges them again and again. High-ability children with Asperger’s syndrome often delve into one topic for a long time. They often adhere to the usual things to the extreme to establish non-functional routines. If something changes, they react with hysterics (e.g., a change in their regular route). Repetitive movements of the hands and body are also common (e.g. , flapping, flitting hand movements in an excited state, rocking back and forth, unusual posture)

Early signs of autism in babies (6 months to one year) may include:

• Smiling rarely in social situations
• Unexpected reactions to new faces
• Little or no eye contact
• Doesn’t respond to their name
• Doesn’t turn their head to locate sound or react to loud sounds
• Overreacts to sounds
• Displays a lack of social ‘anticipation’. For example, baby doesn’t reach out their arms to be picked up, or doesn’t seem to understand the game of ‘Peek-a-Boo’.
• Doesn’t use ‘chatter’ or ‘babble’
• Doesn’t use gestures such as pointing or waving in context.
• Dislikes being cuddled or touched
• Displays repetitive and unusual body movements.

Early signs of autism in toddlers up to 24 months may include:

• Does not speak
• Only walks on their toes
• Unable to follow simple verbal instructions
• Doesn’t imitate actions
• Has an intense interest in certain object and gets ‘stuck’ on them, such as constantly flicking a light switch.
• May be very interested in ‘unusual’ objects, such as metal objects.
• Engages in repetitive activities, such as lining up objects.

Early signs of autism in young children up to 36 months may include:

• Has limited speech
• Has difficulty understanding simple verbal instructions
• Has little interest in ‘pretend’ or ‘imaginative’ play
• Shows little interest in other children
• Likes to follow routine and gets easily upset by change.
• Is extremely sensitive to sensory experiences, such as sight, sound, smell and taste.
• Is under-sensitive to sensory experiences such as hot and cold, touch and pain.

Regular follow-up of development based on screening examinations
Targeted observation of the child as follows [4]:

• use of gaze;
• warm, joyful facial expressions accompanied by eye contact;
•  sharing interest or pleasure;
• response to name;
• coordination of eye contact, facial expression, gestures, and tone of voice;
• showing;
• prosody;
• repetitive movements or postures of the body, arms, hands, or fingers;
• repetitive movements with objects.

If we see a discrepancy:
• targeted hearing test;
• access to early development services;
• targeted autism screening using CHAT.

The CHAT screening test [5] is recommended to be performed between 18 and 24 months of age. Its evaluation is simple; it has five key elements: A5 (symbolic play), A7 (pointing to attract attention), Bii (joint attention), Biii (like a game), and Biv (pointing to an object). If the child underperforms in all five elements, it indicates a high risk of autism. Those who perform below only in the A7 and Biv elements show a medium risk. A further autism-specific diagnostic test is required if the child does not perform well in the control test after one month. The screening test is particular for autism but cannot screen out mild cases. Find below the M-Chat Screening test.
If autism is suspected based on the above:
• a complex child psychiatric, psychological and special education examination is recommended.

Children with more severe symptoms than those with a pervasive developmental disorder may have an autistic disorder. Autism is characterized by more severe disabilities in social and linguistic functioning and repetitive behavior. Often the patient has to face mental retardation and seizures. Check out M-Chat screening test in the related articles.

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