The Quirky Kid Clinic
A common question new parents ask us at The Quirky Kid Clinic is ‘What do we need to look out for in relation to an Autism Spectrum Disorder (ASD)?’. The following article will discuss what ASD is, the diagnosis of ASD, and what to look out for if you have developmental concerns for your child.
What is ASD?
ASD is a developmental disability characterised by marked differences in social interactions, deficits in verbal and nonverbal communication skills, restricted and repetitive interests/behaviours, and sensory sensitivities. It appears in infancy and the symptoms and severity differ from individual to individual.
The severity of an ASD presentation can range from ‘Level 1 requiring support’, through to ‘Level 3 requiring very substantial support’. When ASD is diagnosed it includes the inclusion or exclusion or an accompanying intellectual disability (American Psychiatric Association, 2013, p. 52).
There is no known cure for ASD, and there is no current consensus amongst medical professionals on the precise cause of ASD. However what is clear is that quality individualised early intervention will support children to increase skill development, communication abilities and develop flexible adaptive behaviours (Dawson et al., 2010).
How is ASD diagnosed?
ASD has shown to be reliably diagnosed in a child as young as 18-24 months old (Charman et al., 2005). However, historically children have been more likely to have received a diagnosis closer to school age than during their toddler years (Mandell et al., 2005; Moore & Goodson, 2003).
Howlin & Moore (1997), who conducted a study of 1200 participants in the UK, reported that whilst the average age parents had any developmental concerns for their child was approximately 18 months old, for the majority of participants studied, the diagnosis did not actually occur until closer to the child turning 6 years old.
In response to ongoing research in the area of ASD diagnosis, in the United States, the American Academy of Pediatrics has now recommended that all children be screened for ASD at approximately 18-24 months old (Johnson & Myers, 2007).
In Australia, Williams et al. (2008) have concluded that currently, we have not matched initiatives occurring in other countries, such as the United States, in relation to early ASD diagnosis and early intervention support initiatives. However, the Autism CRC under the guidance of Professor Andrew Whitehouse and colleagues are currently developing a National ‘Best Practise’ Guideline document for the diagnosis of ASD within Australia. Whilst the document has not yet been finalised the draft submission cites the reliability of an ASD diagnosis for a child of 2 years old by a qualified professional. Although, it is still most common in Australia for children to receive a diagnosis between the ages of 3 and 5 years old (Whitehouse et al., 2017).
A reliable diagnostic process involves identifying the child’s strengths and weaknesses via a comprehensive formal assessment which includes a child observation, such as the Autism Diagnostic Observation Schedule (ADOS-2), a parent interview, such as the Autism Diagnostic Interview-Revised (ADI-R), and cognitive / developmental testing such as an IQ test or a general developmental assessment, completed by an experienced practitioner (Charman, 2010; Whitehouse et al., 2017).
Following diagnosis, access to individualised early intervention with the aim of increasing developmental deficits, and decreasing challenging behaviours can make a huge difference in your ASD child’s developmental pathway.
Early Signs to look out for in infants
Identifying characteristics of ASD in a child younger than two years old can be difficult. Concerns may arise due to the ‘absence’ of behaviours considered to be ‘normal’ development and the ‘presence’ of behaviours considered to be ‘abnormal’ development.
Developmental milestones occur across age ranges so your child may be ahead or behind their peers with respect to milestones such as crawling, walking, and early verbal and nonverbal language development.
Listen to your ‘gut instinct’ as a parent. Consider seeking help from your Child Psychologist or Paediatrician if your 12-month-old infant is not demonstrating the following behaviours, either as an emerging skill that is continuing to progress, or once learnt, does not demonstrate these behaviours consistently across multiple environments (Boyd et al., 2010; Charman, 1998):
- Responding to their name, or to the sound of a familiar voice, by turning their head and referencing the person who spoke or the direction from where the voice came from;
- Referencing a familiar person with eye contact, such as smiling in reciprocation to being smiled at, at times such as feeding, and or when playing ‘peek a boo’ like games;
- Demonstrating joint attention, such as referencing a favourite toy or food, then referencing a familiar person, then looking back towards the item of interest as if to say, “pass it to me”, or “can I have more”;
- Babbling or making noises to get a familiar adults attention;
- Developing an imitation repertoire such as waving and clapping, and or including the imitation of a familiar person’s facial expressions and movements;
- Demonstrating reciprocal interest and enjoyment in play, such as tickles, ‘peek a boo’ like games and cause and effect toys, coordinating eye contact to indicate “more”;
- Tracking objects or familiar people visually around the room and or following a familiar person’s gestures, such as pointing to an object;
- Coordinating gestures in order to communicate, such as pointing at an object to initiate a communication, or waving goodbye;
- Positively responding to cuddling, and or reaching out to be picked up.
Remember that your child may, like all individuals, experience good days and bad days. Your child’s development will occur in spurts and patterns, and it is best to evaluate your child’s development by considering the consistency and frequency of these emerging skills.
If you feel a particular skill is lacking spend the time to practise the behaviour with your child, ensuring that you are providing attention and praise for your child’s attempts at demonstrating the behaviour. If the skill does not start to develop or your child responds negatively to your attempts to model and teach the skill then seek help from your Child Psychologist or Paediatrician.
Seeking Intervention
Commence an individualised early intervention program as soon as possible. Whether your child has a formal diagnosis or not it is advisable to start intervention as soon as you suspect that your child’s development is not progressing at the level expected for their age rather than following a wait and see approach.
Here at The Quirky Kid Psychology Clinic, our experienced team of Psychologists are more than happy to meet with you to discuss any concerns you have in relation to your child’s development and behaviour.
We always start with a parent only consultation to ensure that we get a thorough understanding of your child’s developmental history and a sense of your families identity, history and cultural dynamics. From here we provide an individualised case plan dependent on your child and families needs. Please don’t hesitate to contact our friendly reception on (02) 9362 9297.
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References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Boyd, B. A., Odom, S. L., Humphreys, B. P., & Sam, A. M. (2010). Infants and toddlers with autism spectrum disorder: Early identification and early intervention. Journal of Early Intervention, 32, 75-98.
Charman, T. (1998). Specifying the nature and course of the joint attention impairment in autism in the preschool years: Implications for diagnosis and intervention. Autism, 2, 61-79.
Charman, T. (2010). Developmental approaches to understanding and treating autism. Folia Phoniatrica et Logopaedica, 62, 166-177.
Charman, T., Taylor, E., Drew, A., Cockerill, H., Brown, J. A., & Baird, G. (2005). Outcome at 7 years of children diagnosed with autism at age 2: Predictive validity of assessments conducted at 2 and 3 years of age and pattern of symptom change over time. Journal of Child Psychology and Psychiatry, 46, 500-513.
Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., & Varley, J. (2010). Randomized, Controlled Trial of an Intervention for Toddlers With Autism: The Early Start Denver Model. Pediatrics, 125(1), e17–e23.
Howlin, P., & Moore, A. (1997). Diagnosis in autism: A survey of over 1200 patients in the UK. Autism, 1, 135-162.
Johnson, C., & Myers, S. (2007). Identification and evaluation of children with autism spectrum disorders. Pediatrics, 120, 1183–1215.
Mandell, D. S., Novak, M. M., & Zubritsky, C. D. (2005). Factors associated with age of diagnosis among children with autism spectrum disorders. Pediatrics, 116, 1480-1486.
Moore, V., & Goodson, S. (2003). How well does early diagnosis of autism stand the test of time? Follow-up study of children assessed for autism at age 2 and development of an early diagnostic service. Autism, 7, 47-63.
Whitehouse, A.J.O., Evans, K., Eapen, V., Prior, M., & Wray, J. (2017). The diagnostic process for children, adolescents and adults, referred for assessment of autism spectrum disorder in Australia: A national guideline (Draft version for community consultation). Autism CRC Ltd.
Williams, K., MacDermott, S., Ridley, G., Glasson, E. J., & Wray, J. A. (2008). The prevalence of autism in Australia. Can it be established from existing data?. Journal of Paediatrics and Child Health, 44, 504-510.
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