Read for more information about screening and diagnosis, and as usual, ask us about any questions you might have.
This is an edited transcript of an interview with Dr. Susan Levy, who is a developmental pediatrician and medical director of the Regional Autism Center at The Children’s Hospital of Philadelphia. She is a member of the American Academy of Pediatrics Autism Subcommittee.
What is autism?
Autism is one of a group of developmental disorders, the category of which is called Autism Spectrum Disorder or what people commonly say are the ASDs. Children who have ASD have problems with social interaction, communication, and restricted or repetitive behaviors. The other diagnoses in this category are Asperger’s Syndrome and Pervasive Developmental Disorder - Not Otherwise Specified, or PDD-NOS. And even though there are three diagnoses in the category, each child, regardless of which diagnosis they have, has different ranges of development and issues, and how many symptoms they have and how severely they’re affected can vary greatly from one child to another. Although many people have heard these terms, the most recent classification of autistic disorders does not single them out, preferring to lump them under the autism diagnosis.
What are the early signs of autism?
Every child with an Autism Spectrum Disorder or autism can have different symptoms, so the early signs are very variable. We’ve started to call some of the early signs red flags to really emphasize how important it is to recognize them and bring them to attention of professionals. Young children who have a red flag, it may not necessarily be a sign that the child has autism, but it should really result in an evaluation by the child’s family doctor or a specialist.
Red flags can be different according to how old the child is and any other delays they may have. For children under 2, the really important red flags are no babbling by 12 months; no gesturing, which includes pointing or waving bye-bye by 12 months; no single words by 16 months; and no two-word phrases by 24 months, not just repeating words. The most important red flag that we need to keep in mind is if a child has any loss of any language or social skills at any age they should be evaluated by their pediatrician or a specialist as soon as possible.
For older children the red flags or the early signs may be more subtle and they involve how they communicate with other people, whether it be peers or adults, how their social skills are and interaction with other people and may include any unusual or repetitive behaviors. Some of the examples of communication concerns are: that the child does not respond to his name; that the child may appear deaf at times or have inconsistent hearing; if the child doesn’t point or wave bye-bye or use gestures. Important social concerns are if the child is serious and doesn’t smile socially or appears serious; the child seems to prefer to play alone or is just not interested in interacting with other children; the child has poor eye contact or seems to be in his own world and has been described as tuning out others. And lastly, the behavioral concerns include a child who gets stuck on things over and over; may do the same activities repeatedly; gets upset by what seem to be minor changes in either routine or what’s going to happen; has obsessive interests or has some unusual motor actions, such as flapping their hands or rocking their body or spinning themselves or objects in circles.
When should children be screened for autism?
If a parent or a clinician has any concerns about development or has seen any of the red flags, in essence, they’ve already been screened and they should be referred for further evaluation. The American Academy of Pediatrics recently recommended that pediatricians monitor every child’s development or what they call surveillance at each well-child visit.
If a parent has any concern or a child has any of the red flags that I talked about, the pediatrician should work to help the family with getting a referral for further evaluation either in the community or through early intervention services of the school district.
When is autism usually detected?
Research so far has shown that signs of autism are often evident before 3 years of age, and we feel pretty comfortable that we can reliably diagnose it by that time. More recently there have been some studies that have described that routine screening has helped us to identify the children even earlier who may be at risk for a diagnosis, which may be closer to age 2. And we’re really hopeful that as we start to use more consistent screening that we can identify children at risk who are even younger than 2 years old.
About 20 percent of children who end up having an Autism Spectrum Disorder will have a loss of social or language skills called a regression, which was the red flag that I mentioned before that should result in immediate referral, and they have this about 18 months to 24 months. That should bring them to the attention of medical or developmental specialists to really look for the cause of this regression. We hope that through increased awareness by families and clinicians, and it’s in the news all of the time, and some newer strategies for screening that we really can keep lowering the age that we can identify children at risk for having the diagnosis.
A child who has Asperger’s Syndrome might not be diagnosed until he or she is a little older, probably early elementary school age, as his or her language may not be as delayed and they may not have as many significant issues in the early years.
Why is it important to detect autism early?
Research has shown that children who’ve been diagnosed early, particularly 2 and under, and have started treatment have the best outcome. Most children who have an ASD may benefit from different types of treatment, including behavioral treatment, speech language therapy, occupational therapy and sometimes physical therapy, and these types and intensity of therapies are based on the child’s strengths and weaknesses.
If you have questions or concerns about autism, please contact us to discuss these issues. Families can also contact state-funded early-intervention services for children under 3 or their local school district for children older than 3 to request an evaluation and potentially receive services. Find information on early intervention at www.nichcy.org.
Connecticut - call (800) 505-7000 | www.birth23.org.
New York - call (518) 473-7016 for the county number.
Westchester - call (914) 813-7016.