Ever since I started speaking about my son’s autism diagnosis at 17 months, I’ve had a lot of friends and strangers approach me with concerns about their own children. Even though study after study shows the importance of starting therapy as soon as possible for autistic children, most aren’t diagnosed until after 4 years of age, even though studies show autism can be properly diagnosed much earlier, as young as 6 months. Why the long wait? Several reasons, chief among them is that, as I wrote about earlier, many parents often have their concerns dismissed. On top of that, early signs of autism are missed, even by experts, in the short period of a well-child visit. Even if a parent’s concerns are taken seriously, and experts confirm the warning signs, shortages in pediatric specialists mean that parents often can’t get a timely appointment, which is part of the reason for the 2 year gap between when problems are first noticed and when children are diagnosed. These difficulties and delays in obtaining services are part of these reason I’ve become so proactive in encouraging parents to screen their infants and toddlers themselves as much as possible. As my experience in this area covers infants and toddlers, that’s what I will focus on.

In a series of posts, I will cover these 3 separate topics related to questions parents frequently ask me:

1. What are the early warning signs of autism? How can I tell the difference between a sign of autism and normal behavior?

2. I noticed some red flags in my baby or toddler. Now what?

3. What can I do now at home to help prevent or treat developmental delays?

Part 1

What are the early warning signs of autism? How can I tell the difference between a warning sign of autism and normal behavior?

Autism Spectrum Disorder is characterized by two main aspects: 1. impairment in social interaction and/or communication. 2. unusual and often repetitive behaviors and interests. As communication delays and repetitive behaviors are not uncommon in young children in general, many parents are unsure if a behavior is a “red flag” or a typical toddler behavior. When evaluating for autism, it is important to keep two things in mind,

1. It is the sum of the behaviors or lack thereof that leads to the diagnosis, not the individual behaviors themselves. For example, hand flapping, rocking, head banging, lining up toys, etc, can all be seen in neurotypical children as well. A red flag for autism doesn’t necessarily mean that the child is autistic; for example, a child who isn’t babbling correctly or responding to their name appropriately may be having hearing difficulties due to ear infections.

2. Autism is a spectrum disorder, which means that a child can receive a diagnosis even without sharing many characteristics seen in autistic children. My autistic son does not hand flap, rock, head bang, line up toys, or engage in several behaviors seen in many other autistic children. He also made great eye contact from a distance, was the first of the twins to smile, imitated more easily and often than his brother, etc. I’ve had a lot of people dismiss or disbelieve my son’s diagnosis after a brief interaction because of how much he can do, especially now that he is on track with his verbal skills. Many people expect a child diagnosed as young as mine to act more stereotypically autistic. However, I started noticing the signs of autism before his first regression, even though he passed his 6th and 9 month screenings, and there’s a good chance that, had we not caught it early, he might’ve ended up with a more ‘traditional’ autism trajectory.

Keep Track of Developmental Milestones

Based on my experience, I recommend all parents be on top of developmental screening at home. Know what to expect at each age and what skills your child should be able to accomplish. Normally children with autism aren’t diagnosed by what they are doing, but what they aren’t.

The CDC has a list of important milestones you should expect between 2 months to 5 years. In each category, they note warning signs that should be brought up to your child’s doctor. Here is a video by the CDC that discusses watching for milestones and noting delays.

The Ages & Stages Questionnaire covers the first 5 years and can be accessed through Easter Seals. You can also download the PDF of the master set here. A score in the grey is not much of a cause for concern, but a score in the black, in any category, is worth a call to Early Intervention. If you are having trouble figuring out how to score it, feel free to message me and I’ll help you through it.

If your child was born prematurely, as were my boys, then it’s important to pay attention to the adjusted age rather than the actual age. It’s also important to note that neurotypical children, especially preemies, have delays as well, so finding a developmental delay doesn’t necessarily mean that a child has a developmental disorder. Both of my twins had delays deep enough to refer to Early Intervention, but only one received the autism diagnosis.

Watch Out For the Red Flags of Autism

The Autism Science Foundation has an excellent list of Early Signs of Autism covering 2 months to 5 years. The first one I noticed at 4 months is not covered on this list. I noticed then that my son would turn his head away from my face when I played close-up games such as patty cake. He also seemed to be easily overstimulated by my presence. I found this video on the early warning signs of autism very informative at around 11 months, even though most children in the video were much older than my son. I recognized my son’s fixation on parts of certain toys and how differently he played with toys compared with his twin.

If your child is between 16 and 30 months of age, you can take the M-CHAT, which is a tool designed to screen for autism.

One of the biggest warning signs of autism is a regression. While small regressions in sleep, potty, training, speech are fairly common, especially if there has been a big change like a move or arrival of a sibling, any loss of speech, babbling, gestures, or social skills should be taken very seriously as regression, especially without a clear cause, is a major red flag for autism. When my son went through his first regression at about a year of age, he stopped babbling, stopping making eye contact as much, and started spending more time by himself playing with a toy in a specific way over and over and over again. If I hadn’t already been very close attention to his development, I probably would’ve thought that the regression was when he ‘suddenly developed’ autism. After all, he had passed 2 earlier screenings by Early Intervention.

At this point, you should have a good idea if your baby or toddler is on track or if there are delays. If your child is on track, simply keep monitoring, as some signs of autism don’t develop until later. If your child is developmentally delayed or you notice some red flags, then read on to

Part 2:  I noticed some red flags in my baby or toddler. Now what?