Should an Eighteen-Month-Old Be Seen by an Autism Specialist? Yellow Flags

As we all know, various Internet sites proclaim “red flags”, or behaviors of young children that may be associated with a later diagnosis of autism. Unfortunately, these “red flag” sites usually neglect to explain the considerable overlap between typical and atypical behavior, or the fact that behaviors very typical of infants can closely resemble the behavior of older children diagnosed with autism. Worried young parents see one “red flag” behavior that is characteristic of their [usually quite young] infant and convince themselves that they must find treatment at once.

But in fact, for children under the age of two or three years, atypical behaviors are only “yellow flags “, or “caution” signs, and even that only if several of them are seen. A small group of “yellow flags” in a toddler simply suggests that the child should be observed and his or her development should be watched more carefully than might usually be needed. These “yellow flags” act as a screening device that helps to focus on a small number of children of whom some are going to need special help.

                        Quite a few years ago, the British psychologist Simon Baron-Cohen (yes, brother of you-know-who!) developed a checklist to help pediatricians screen for toddlers who should be seen by an autism expert. Now, let me point out once again that these children are EIGHTEEN months old or older when screened with this checklist. They are not 12 months or 6 months, and they certainly are not 4 weeks old!  Let me also point out that one or two or even three atypical responses does not mean a diagnosis of autism; this whole thing is about finding the small number of children whose diagnosis needs a highly specialized professional examination that can rule out this particular problem for many of the kids.

So, given all that, here are some questions that might be asked a parent of an 18-month-old:

Does your child enjoy being swung, bounced on your knee, etc.?

                        Does your child like climbing upstairs or up on other things?

                        Does your child enjoy peek-a-boo and hide-and-seek?

                        Does your child ever PRETEND? (Baron-Cohen uses the Brit example of pouring                         and drinking tea, but other examples might be stirring a spoon in an empty                                                    pot, or using an electric cord as a “stethoscope” after visiting the doctor.)

                        Does your child ever point a finger to ASK for something?

                        Does your child ever point a finger to show INTEREST in something?

Can your child play with objects by rolling a toy car or building with blocks, rather than just mouthing or dropping them?

Does your child ever bring objects to you to SHOW them to you?

Notice, by the way, that some of these questions ask whether the child EVER does certain things. The fact that he or she does not do them all the time is not important, but if they are never done, that may be important.

Baron-Cohen’s list then goes on to questions for the pediatrician and what he or she has observed about the child:

During the appointment, has the child ever made eye contact with you?

If you get the child’s attention and then say “oh look!” as you point at an interesting object, does the child look where you are pointing?

If you get the child’s attention and then give him or her an object that could be used to pretend (the teacup again--  but any toy can be used ), and ask if he or she can drink the tea, stir the pot, etc., does the child do so?

If you ask the child to show you a light or other object, does the child look up at your face and then POINT?

Can the child build a tower of two or more blocks?

Once again, the issue is whether the child does most of these things a lot of the time. If he or she does, the possibility of a later diagnosis of autism is remote. If the child does not do most of the things mentioned, there may still be reasons other than autism for the problem, but it would be a good idea to see a specialist who can make sense of what is going on. Whatever the trouble may be, it may be time to seek treatment and help to move the child along developmentally as much as possible.

That was EIGHTEEN months, remember! And those flags are yellow.