The First Signs

Many new parents ask what are the first signs to look for to determine if their
child could have an Autism Spectrum Disorder (ASD)?  There is no one answer to
this question since presentations vary.  A close relationship with your
pediatrician and participation in appropriate developmental surveillance are the
most important ways to assure an early diagnosis is made. You and your
pediatrician are in the perfect vantage point to collaborate in the early
diagnosis. There have been numerous published reports about the early signs of
autism. The key is for both of you to take the time to look for the signs of
autism, know what these signs are and have a strategy to systematically evaluate
the developmental trajectory of your child. This, however, is the easy part. The
hard part is being aware of available regional community, educational and
medical resources and then collaborating with your pediatrician to pursue and
obtaining the services you and your child require.

Key signs relate to atypical language development and social deficits that include delayed or absent joint attention (JA). These children appear to lack connectedness. They are often content being alone and show decreased eye contact. They initiate and
maintain social contact with gestures, vocalization and eye contact less than
expected for age and have difficulty sharing emotional contact with others in
play or group activities. Joint attention delays are frequently seen in infants
less than one year of age who do not show enjoyment from looking back and forth
in a sharing fashion between a person and a joint object of interest. By age one
year most children with prompts will look in the direction that their parent
points and will then look back to the parent with a shared expression. By 15
months most children will point to request a desired object and soon thereafter
will point to share a joint object of interest. While pointing the child will
look back and forth between the object of interest and the parent showing a
shared social experience. This sharing is often absent in children with ASD. The
absence of joint attention effects language development and the “showing” of
positive affect  and social connectedness.

Orienting to one’s name being called is often deficient in children with ASDs as well as children with decreased hearing. Hearing assessment is essential in any child felt to have an ASD. As a child with ASD enters the preschool years he is less likely to develop age appropriate peer interactions and any shared interests usually center on a
limited set of interests that revolve about his own special interests. They
often have difficulty understanding the perspective of others and  difficulty
understanding the context of situations and events. This inability to understand
the big picture makes social interactions difficult. The ability to recognize
the mental state of others by late preschool years is also lacking and leads to
difficulty with empathy, sharing and comforting.