Early Indicators of Autism

Over the last 10 years, researchers have identified several red flags to consider in the early diagnosis of autism. Some research is based on retrospective video analysis of social, communication, and play behaviors in the first two years of life for those children later receiving a diagnosis of autism. Other research uses screening methods of children at risk with follow-up over time to determine if the diagnosis is maintained and what might be predictive at 18, 24, and 36 months of age.

We have learned that there are key factors alerting families and providers to the possibility of autism. These include:

• absence of or delay in pointing to express interest
• hand leading or using another's body to communicate, often replacing pointing
• failure to show interest in or joint attention to games for pleasure or connection with another
• failure to "show" objects
• failure to look at others
• failure to show an interest in other children
• failure to orient to name or delayed response to name; lack of attention to voice, particularly neutral voice
• no meaningful words or fewer than five meaningful words at 24 months, or cessation of talking after saying three or more meaningful words
• no understanding of words out of context
• failure to demonstrate symbolic play
• aversions to social touch, poor nonsocial visual orientation/attention, excessive mouthing of objects
• unusual mannerisms involving the hands and/or fingers

Recognizing early indicators is just the first step in the assessment process. Currently, there are efforts in both child neurology and pediatrics to more clearly specify practice parameters for screening and diagnosing children suspected of Autism Spectrum Disorder.

The Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society has issued a report with practice parameters for both the screening and diagnosis of Autism Spectrum Disorder (Filipek et al., 2000). The screening parameters indicate that professionals must include or consider:

• formal hearing testing
• further evaluation if there is no babbling or gesturing by 12 months,
• a loss of language or social skills,
• no single words at 16 months,
• no two-word phrases by 24 months
• monitoring siblings for social, communication, and play skills because of the potential genetic link