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Autism: In this day and age, it is difficult to scan the media without some reference to this disorder. Everyone understands the word, and can recognize the context, but what really is it?
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Actually, Autism is more of a collection, or group of problems rather than any single describable issue. It's often described as a spectrum of disorders under the Autism umbrella; yet with distinct issues for each family.
No concrete sign or test can identify any one child as having Autism; this class of problems is mostly concerned with social interactions. Affected children may seem to not care about the others around them. They also may have verbal and non-verbal communication problems. They may have restricted interests or focus too tightly on a single object or subject. This may sound like several people you know, but this alone does not spell Autism. Not all children with some of these traits have a problem. It is the pattern of these factors that lets the professional decide if there is more to it.
What should one look for? Parents usually are the first to notice unusual behaviors. Uninterested in people, focusing intently on one item for long periods of time? The baby just seemed ÓdifferentÔ from birth? Or the first signs may not appear for awhile until the engaging social toddler suddenly becomes silent, withdrawn, or indifferent.
Most newborns are pretty self-centered, so lack of social behavior is not immediately significant. Now some experts do feel that kids younger than 12 months can be identified with this problem. But, as a general rule, most early cases are found between 12 to 18 months.
Reliable evidence can be seen by age three, but, even with thorough screening, only 50 percent of cases are discovered by kindergarten! It is not so easy for parentsÅor even professionalsÅto make the call.
Yet parents usually are first to notice developmental problems. When visiting the pediatrician do not hesitate to speak up if you feel Óthings are not right.Ô This can help lead to important early diagnosis.
What are we looking for?
All children are unique. Just ask parents of more than one child. Problematic children also present their own personal collection of social, communications and behavioral issues. And these must be sorted out for the doctor to make the diagnosis.
From the National Institutes of Health, here are possible indicators of Autism Spectrum Disorders:
Does not babble, point, or make meaningful gestures by one year of age
Does not speak one word by 16 months
Does not combine two words by two years
Does not respond to name
Loses language or social skills
Poor eye contact
Doesn't seem to know how to play with toys
Excessively lines up toys or objects
Is attached to one particular toy or object
Doesn't smile
Social Symptoms:
People are social! We like others, we look at others, we respond to the sounds of others, (unless we are in New York City). Babies will grab an offered finger and smile at the attention. Babies who will not offer eye contact, or seem not to react to offers of social interaction may be a problem. Children with Autism may marginally tolerate or even reject hugs and snuggles. They cannot tell if you are mad, sad, glad, or neutral, regardless of how much you over-act. They seem to miss all the social clues we provide through mannerisms and actions. They lack social awareness, because, in their world, they really are alone!
Communication Challenges:
As your child grows, regular pediatric checkups should include some questioning about language and communication. From babbling to grunting and pointing, and the first words, these are all early forms of communication. In Autism, this process may never start, or start late, or start and just stop. Tell the doctor. Also, non-communicating children, will react with growing frustration when you cannot read their emotional state or understand their needs and desires.
Repetitive Behaviors:
Children with Autism Spectrum Disorder have normal physical strength and good muscle tone. They look like everyone else at their age. But, in a schoolyard full of children, their behaviors will be different. All children at times run around flapping their arms and imitating birds or planes. But when that behavior becomes a constant norm and the child does not progress into real games, this may be evidence of a problem.
All children, like adults, follow a schedule of living. Up for breakfast, get dressed, off to school.
Children with Autism Spectrum Disorder do so as well. But, move a toy out of turn; miss a step, or make even a slight change in the pattern and they'll find it drastically disturbing.
In summary, Autism Spectrum Disorder is a vast field of problems ranging from the mildest hint of an issue to vastly abnormal behaviors. These issues can be in speech, language, or social, behavioral or intellectual or medical. It takes a team approach to evaluate and treat these problems. Still, the child's parent is the best observer. Try to keep your child up to date on well visits, as the health care provider also screens for problems. If you are in doubt or have questions, call or see your health care provider.
(Dr. Marz, a board-certified pediatrician, is supervising physician for the Town of Barnstable school system. He practices with Bass River Pediatrics in South Yarmouth.)