Early Signs / Characteristics
Know what to look for
Parents (and grandparents) are often the first to suspect that a child might be on the autism spectrum. If parents are concerned, they should discuss their observations with a family doctor, pediatrician or nurse practitioner. Some health care professionals may advise a “wait and see” approach or suggest that your child will “catch up”. If your child has normal development and then regresses, you should seek help immediately.
Early screening of a child results in an earlier diagnosis and more effective treatment. The earlier the diagnosis can be confirmed by a specialized diagnostic team, the earlier any necessary treatment can begin.
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You may help educate your health care practitioners by sharing our Autism Physician Handbook and pave the way for other families to get an early diagnosis. We do not print hard copies of the Handbook. You can download a copy here.
Recognizing the early signs of autism can lead to optimal outcomes. It is critical to know what to look for in a child.
(12 to 24 Months)
We are all unique
Each person with an Autism Spectrum Disorder (ASD) is unique.
Words used to describe an individual who is on the autism spectrum are being questioned more and more by the autism community. Terms such as “mild” or “severe” and labels like “high-functioning” and “low-functioning” are not particularly accurate and could be viewed as harmful. Someone who can’t talk might have better social skills than someone who speaks well. What if the person who can speak is unable to pick up on social cues? A medical diagnosis might label the non-verbal individual as being more “severely” autistic than the verbal one. While individuals with autism are on a spectrum, the line is possibly more blurred than originally thought.
Some children and adults with autism have serious cognitive disabilities and sensory problems. They may display extremely repetitive behaviours including meltdowns, self-injury, defensiveness and aggression. These are often provoked by anxiety and/or pain. Without appropriate intervention and an understanding of the underlying cause, behaviours may become persistent and difficult to change. Living with and caring for a person with autism can be challenging, requiring tremendous patience and an understanding of the condition.
Individuals with ASD may present with
some of the following exceptional characteristics:
The above exceptional skills may be combined with subtle characteristics in other areas of development. All individuals with the diagnosis demonstrate some of the following:
Autism is characterized by an impaired ability to engage in social relationships and can result in serious deficits in the ability to make friendships. In fact, children on the autism spectrum often behave as if other people do not exist. This is demonstrated in various ways, including failure to respond to their names when called, appearing not to listen when spoken to, an inability to display appropriate facial expressions, avoidance of eye contact, a failure to respond to affection and sometimes treating people as if they were inanimate objects. Often children will acknowledge an adult only for the purpose of getting a need gratified and will return to ignoring the adult thereafter.
If a child with autism possesses any social skills, they are characteristically rote and awkward in nature. Individuals with autism also experience problems maintaining reciprocal relationships. Additional difficulties center around an inability to take on another’s perspective (e.g. a child with autism hurts another child and cannot understand why he/she is crying), feelings and emotions, or provide or seek comfort, in conventional ways.Unusual seeking of comfort when stressed
Individuals with autism tend to crave predictability and function optimally in highly structured situations. Concurrently, they are likely to become extremely dependent on elements of sameness in their lives, to the extent that they can have difficulty coping with changes in their environment or routine. Whereas most people seek reassurance when faced with fear, pain or insecurity, individuals with autism react this way to seemingly harmless objects or situations possibly because they associate them with a previous unpleasant experience.Impaired imitation skills
All children learn behaviour patterns of social interaction through imitation. Very young children with autism will often fail to respond or exhibit delays in responding to the gestures or playful overtures of peers, even when these are familiar to them from past experience or through repetition.
With carefully planned intervention efforts over time, the child’s capacity to benefit from imitative learning will increase.Unusual toy play
When a child with autism sits down to play, he/she generally has a stereotypical and repetitive approach as opposed to the symbolic, creative and imaginative play behaviour exhibited by the typically developing child. Some children may refuse to play with toys, or if they do they may do so in unusual ways. They may not see a toy car as a car but rather as an object that rattles and makes funny patterns when the wheels are spun. This unusual toy play probably accounts for part of the reason why these children have difficulty interacting with peers and joining in games with others.Inability to form friendships
Children with autism lack two essential skills that are vital for peer connections:
- The ability to relate to peers in a positive and reciprocal manner
- The ability to adapt interpersonal skills to the various demands of different social situations.
These children are not looking for opportunities to interact and may even find it difficult to be in the physical proximity of others. Typically, they are not sought out by peers for play.
Difficulties using and understanding verbal and non-verbal language are exceedingly common in children on the autism spectrum. Deficits can be found in these areas:
- The development of spoken language – no speech
- Responses to the communications of others (e.g. won’t look)
- Failure to initiate or sustain conversations (e.g. turn taking)
- Pronoun confusion (e.g. using “I” instead of “you”)
- Stereotypical and repetitive use of language (using lines from a favourite movie to communicate)
- Idiosyncratic use of words and phrases (e.g. always salutes and says “Yes sir” when given a direction)
- Abnormalities in pitch, stress, rate, rhythm and intonation of speech.
Communication involves both understanding language (receptive skills) and providing information (expressive skills). The abilities of these children vary widely in that some children on the autism spectrum will have a good grasp on comprehension (e.g. “sit down”) but lack expressive skills (e.g. “my tummy hurts”) and vice versa. Regardless, many children on the autism spectrum experience difficulty with non-verbal communication (e.g. eye contact, facial expressions, smiling, etc.). Children on the autism spectrum often fail to understand words or phrases that are abstract (e.g. “we’ll go swimming later” or “I love you”) or that have a double meaning (e.g. the teacher says to a child on the autism spectrum, “Clear off the table” and he goes over and pushes everything off it). They also tend to interpret things very literally (e.g. “give yourself a hand”).
Some children exhibit echolalia, which is the repetition of words, signs, phrases or sentences spoken by other people. Some children use this as a communication device (e.g. the adult says “Do you want a car?” and the child might say “Want a car” to mean yes). A child may repeat the same phrase over and over again as a means of regulating his/her own behaviour (e.g. a child repeats aloud “Time to clean up” while cleaning).
Children on the autism spectrum typically have a narrow range of interests (e.g. will only go to play in the block area of the classroom). They may also engage in repetitive, stereotyped body movements such as hand flicking, spinning or rocking. They may insist on carrying certain objects around with them to keep from having a meltdown or to help them feel secure. Perseverations might extend to food. A child on the autism spectrum may have a preference or dislike certain colours, textures or temperatures of foods. Some individuals perseverate on certain topics. A child might be intrigued with one or two topics, such as music or modes of transportation. They can exhaust everyone who comes into contact with him or her about that area of interest.
Many children on the autism spectrum are typically highly dependent on a set routine and can become extremely stressed when this schedule is not followed to the letter. An individual might insist on a certain bedtime, mealtime or greeting routine. Behaviour problems (e.g. screaming, meltdowns, self-injury) often occur as a result of changes in routine.
More often than not, children on the autism spectrum exhibit unconventional reactions to sensory stimulation. Some children show a hypersensitivity to stimuli (e.g. can hear lights buzzing, cannot tolerate touch, are fascinated with spinning objects, must smell everything). Others may display a hyposensitivity to stimuli (e.g. demonstrate a high pain tolerance, act as if deaf). A child on the autism spectrum may be fascinated with a piece of lint or may spend hours rocking or watching objects twirl. In general, these types of reactions are providing some sort of sensory stimulation for the child.
It is believed that these sensory difficulties stem from neurological dysfunction in the brain. We are bombarded with thousands of sensations daily. Our ability to integrate these sensations by attending to the important ones while filtering out the non-essential input, helps us to function efficiently. Without smooth functioning of this system, the individual is unable to accurately interpret his/her environment, then respond and adapt.
Behaviour problems are often associated with children diagnosed with Autism Spectrum Disorder. These can include incidents of meltdowns, self-injury, property destruction and acts of aggression. Some behaviours are the result of developmental deficits (e.g. a child cannot speak and engages in misbehaviour as a form of communication). Some could be due to sensory processing challenges. And some behaviours may be due to physical pain or a medical issue.
It is important to remember that behaviour is communication. Therefore, those living with and caring for the child or adult must try to decipher what he or she is attempting to communicate.
A characteristic of individuals on the autism spectrum is the wide range of functioning within which they can fall. Individuals on the autism spectrum can be severely impaired to the extent that they are unable to perform independent skills of daily living, or they may be functioning in the high range of intelligence, attend college, have a career and start a family.
Individuals on the autism spectrum may exhibit a “splintered” development profile. In other words, they are able to function in some areas at levels higher than their overall level of functioning. For example, a four-year-old child on the autism spectrum may be reading books at a Grade 2 level while his self-help skills are at age level and his social skills are non-existent.
Some children on the autism spectrum have trouble falling asleep or require only a few hours of sleep each night to function. This can be extremely problematic for families. Parents often start sleeping in shifts to prevent the child from getting into trouble at night around the house.
Many children have problems with toileting, which is often related to sensory issues or actual gastrointestinal (gut) problems. A great many children have diarrhea or constipation, abdominal pain, flatulence (passing gas) and bloating. Some children have foul-smelling, light coloured stools (feces, poop). Gastrointestinal discomfort could be the cause of poor sleep habits as many individuals suffer from reflux esophagitis.
Some children on the autism spectrum are “picky eaters” and their diets may be limited to a few preferred foods. This self-limiting has often been attributed to food intolerance.
Research has shown that a large proportion of individuals on the autism spectrum show signs of immune abnormalities. Studies are pointing to the immune system pathways as being directly involved in the development of ASD symptoms.
According to some researchers, abnormal immune function is one of the key features of autism and it plays a major role as the condition develops and progresses.
Many children have actual gastrointestinal (gut) problems. If a child displays the following symptoms, consider asking for a referral to a Gastroenterologist:
- Undigested food in stool (feces, poop)
- Severe self-limiting diet and/or food sensitivity
- Abdominal pain
- Bloating and releasing gas
- Foul-smelling, light-coloured stools
Dr. Tim Buie, a Gastroenterologist at Harvard University and Mass General Hospital in Boston, US, has performed endoscopies in over 1000 children on the autism spectrum. In the initial 400 children, he discovered that GI problems were much more prevalent in children on the autism spectrum than in normal controls. His results showed:
- 55% Lactase Deficiency
- 20% Esophagitis
- 12% Gastritis
- 12% Colitis
- 10% Duodenitis