By Tina K. Veale, Ph.D., CCC-SLP, of Midwestern University
Few childhood conditions are as frightening for parents to contemplate as autism. Autism is a complex neurobehavioral disorder that causes social communication deficits and repetitive behaviors. The signs of autism can be present at birth (classic autism), or more commonly, begin between 18 and 36 months of age (regressive autism). Most children who develop autism start their developmental journey in the same ways that neurotypical children do: learning to walk, talk, play and engage with the world around them. And then something goes wrong. Over a period of months, the child loses skills that had been developed. The loss happens a little at a time, and may not seem that worrisome at first. As the pattern continues, adults who know the child become concerned that something is not quite right.
For example, Dani was the first child born to her parents. She was perfect in every way. The product of an uncomplicated pregnancy and delivery, she met all early developmental milestones as expected. Except for a couple of ear infections, she had been a healthy infant and toddler. At age 22 months, her parents noticed some odd changes. Dani was becoming less interested in the world around her and more interested in an ever-narrower range of things and activities. She had always enjoyed having her father play on the floor with her, but she now ignored him when he sat down to play, and sometimes pushed him away. She collected circular items into a pile, and spent hours staring at or spinning them. If interrupted, she became very upset until allowed to play with her circles again. Until recently, Dani loved storytime and her parents read to her several times a day. She was able to point to pictures in her books, imitate words and short phrases, and name familiar pictures. When it was time to read, Dani now resisted. She did not look at the pages, and rarely said anything when her mother read to her. Dani had been able to follow simple directions, but she no longer seemed to listen to anything her parents said. Her speech was becoming more difficult to understand and less frequent. Needless to say, Dani’s parents were beginning to worry. This seemed like more than a developmental stage — and it was. Dani was diagnosed with autism just after her fourth birthday, and began early intensive communication therapy and medical interventions.
Autism is one of the most common developmental disorders of childhood, occurring once in every 68 children born in the United States, according to the latest statistics from Centers for Disease Control and Prevention (CDC). It occurs in all racial, ethnic and socioeconomic groups, and is five times more common in boys (1 in 42) than in girls (1 in 189). These 2014 statistics represent a 30% increase from those collected two years prior, and are an extension of an ongoing trend in increased incidence over the past three decades. What was once a rare disorder has now become one of the most common developmental syndromes around the world. Given the alarming increase in its prevalence, parents, physicians and educators need to know the following warning signs of autism.
First Indications of Autism
- Prefers to be alone rather than with others
- When given the choice will play alone
- Has difficulty engaging with others even with encouragement
- Trouble with turn-taking
- Does not engage in reciprocal turns when playing with toys (like throwing a ball back and forth) or talking (like answering a question, giving someone else a turn to talk)
- Non-communicative eye language
- Does not look at person who is talking
- Does not shift eyes between objects that are being spoken about and the speaker
- Does not look at objects to indicate comprehension
- Does not look at objects to request them
- Slower eye shifting than expected during conversation, indicating possible language comprehension deficits
- Low social responsiveness
- Infrequent smiling to indicate positive emotion, either spontaneously or in unison with others
- Does not wave hello or goodbye, either spontaneously or in response to others
- Does not answer yes-no, what, or where questions, either by pointing, vocalizing, or verbalizing
- Does not nod or turn head to indicate comprehension of conversational messages
- Often seems to ignore ongoing social interactions
- Does not join in play, song, or games
- Unpredictable sensory reactions
- Seems not to hear what is said
- People’s voices and some environmental sounds (water noise, motor noise) often seem to hurt
- Does not like to be touched softly
- Enjoys deep pressure
- Cognitive inflexibility
- Needs activities to be done in the same order all the time
- Needs to finish what has been started, especially common routines
- Has trouble learning a new way of doing things
- Very rigid in thought, action, and language
- Language deficits
- Does not understand language as well as peers
- Produces less language than peers
- Does not understand that some words have more than one meaning
- Interprets all messages literally; does not comprehend implied meaning
- Repetitive behaviors
- Repeats words over and over, seemingly without meaning
- Repeats the same simple activities for extended time periods
Not all children with autism demonstrate all of these warning signs. As a matter of fact, most begin by showing only a couple of them. If your child has developed skills and lost them, or if he shows two or more of the signs above, he should be evaluated for autism. Talk to your child’s physician or teacher, or seek the advice of a speech-language pathologist who has experience with autism spectrum disorders. Go to an experienced autism expert for the diagnostic evaluation and advice about treatment. Early and intensive intervention is the key to successful autism intervention.
Dr. Tina Veale, Ph.D., CCC-SLP is Professor and Program Director of the Speech-Language Pathology Program at Midwestern University in Glendale, Arizona. She has over thirty years of experience working with individuals with autism and their families. Dr. Veale can be contacted at tveale@midwestern.edu.