Worrying About Autism? Some Information

Two posts on this blog draw the most reads and comments week after week: these are http://childmyths.blogspot.com/2011/07/eye-contact-with-babies-what-when-why.html and http://childmyths.blogspot.com/2013/11/infants-autismand-eye-contact.html. Both of these posts have to do with infants’ eye contact with their caregivers, and by extension with symptoms of autism—readers who write comments and queries are almost always worried about autism, not about the visual impairment that might also underlie problems with eye contact. Recently, there have also been concerns about odd movements like hand-flapping that may be associated with autism, and some readers have been worried about whether some hand movements might indicate Rett syndrome.

For worried parents, one of the real problems is that they don’t actually know what “autistic movements” look like. Another is that infants are individuals who often don’t conform to averages of development that parents read in “the books” of norms for developmental milestones; they reach some milestones earlier than the average, then turn around and act a bit delayed on others. In addition, neither autistic or typically-developing children are “all autistic” or “all typical”, and their behaviors overlap quite a bit, especially during the toddler and early preschool periods. A fourth, and very real, problem is that it’s still not understood how autism can be predicted accurately for children who are still under a year old--  but this is exactly the age period when parents are most likely to start agonizing and watching for those “red flags”.

Here is a very fine video that shows behavioral differences between typically-developing toddlers and same-age children who are later diagnosed as autistic:

http://www.kennedykrieger.org/patient-care/patient-care-centers/center-autism-and-related-disorders/outreach-training/early-signs-of-autism-video-tutorial .

When you watch this, please notice that all the children are over 12 months of age. Don’t try to generalize from this information to younger infants. One of the features of autism is developmental delay, so an autistic child may act in some ways much like a younger child--  it’s important to realize that this cannot be reversed to mean that the younger child must also be autistic, or to assume that developmentally appropriate behaviors of the infant are signs of autism.

The first concept covered in the Kennedy Krieger video is the child’s ability to use play in ways that include other people, not necessarily as a formal “game”, but as part of a social interaction like pretending to eat or to feed another person. The typically-developing child in the video offers a “bite” to an observer and takes a “bite” himself. This ability develops after about a year of age, and its absence in a younger infant would be no reason for concern. He also follows what an adult does, imitating in a meaningful rather than a mechanical way. The same-age child who is showing signs of autism does none of those things, and he does not respond to his name, which is unusual at this age (though it would happen much more frequently with children some months younger). Although he acts as if he likes to be tickled by his mother, he doesn’t respond socially.

The second point is the making of social connections by typically-developing children, by looking at people and responding to gestures. The little boy in the video even makes an effort to turn and look at his mother, and he looks at an item pointed at by an adult, continuing the “conversation” by pointing at it again later. Another boy of the same age shows symptoms of autism by flapping his hands in excitement, but without looking at the adult; a typically-developing child may also flap his hands, but he looks at adults while he does so and seems to use the gesture as communication. The autistic child does not look at an object an adult points at, but instead looks at the adult’s finger (as a much younger infant might do).

The third important point in the Kennedy Krieger video is the typically-developing child’s capacity to carry out and enjoy social communication. The child in the video is fascinated by a moving toy, but frequently looks at adults and then back at the toy, while smiling. When the toy stops moving, she wordlessly communicates to the adult that she needs help to start it again. An autistic child of the same age watches the toy carefully, but does not smile at adults or look at them to create social communication. He does not respond to a gesture by which an adult asks to have the toy. His mouth and torso become tense and stiff as he handles the toy.

Watching this video may give you some hints about differences in behavior between typically-developing and less typical children, but remember, these differences do not apply to children under a year of age. There may be differences at earlier ages, but they are not yet well understood. In addition, remember that typically-developing preschool children sometimes do “autistic” things, and autistic children sometimes do “typical” things. It’s the general pattern of behavior that is of importance. Finally, keep in mind that even the children who are diagnosed as on the autistic spectrum as toddlers and preschoolers may well look much more typical as time goes on.