ACTNOW Fact Sheet 3
EARLY FEATURES OF AUTISM
by Dr Avril Brereton
In recent years a number of studies have sought to describe the early features of autism in infants and preschool children. Some studies have interviewed parents to establish what problems initially cause them the most concern, others have observed children in controlled play and assessment situations.
The early features of autism identified in these studies are listed below (Gray & Tonge, 2001).
1. Social interaction
Poor social interaction
Lack of verbal communication
The features listed under the categories of Stereotyped and repetitive routines, behaviours and interests (3), Play and Sensory (4) and Other behaviours (5) are not necessarily present in very young children. This may be because there is a developmental process in the emergence of these autism symptoms.
3.Stereotyped and repetitive routines, behaviours and interests
4. Play and sensory
Lack of spontaneous play
5. Other behaviours
Some of the features listed above are also present in young children with developmental delay. Therefore, studies that have compared the behaviour of young children with autism with those who have developmental delay without autism provide the best information on the features and symptoms of autism in infants and preschool children.
The absence of stereotyped and repetitive behaviour in very young children does not exclude the possibility of autism. The presence of obsessional behaviour may be dependent upon more advanced language and cognitive skills and emerge later as the child makes developmental gains. Deficits in basic communication and social skills are apparent in the first two years of life in young children with autism (Gray & Tonge, 2001; Zwaigenbaum, 2001).
Differentiating between speech delay, developmental delay and autism in young children.
Parents of young children with autism often report delayed speech as their first concern, but speech delay is not specific to autism. Delayed speech is also present in young children with global developmental delay caused by intellectual disability and those with severe to profound hearing loss. Children with speech delays or hearing loss are usually able to compensate for their limited or lack of speech by the use of non verbal communication skills such as using gestures (e.g. pointing), eye contact and facial expression to get their message across. These children also respond to praise, can empathise, imitate and engage in make believe play. Children with developmental delay will also usually attain these skills when their developmental level passes about 12 months of age. However, the child with autism continues to have ongoing problems with delayed and disordered language, social communication skills, empathy and pretend play skills regardless of developmental level (Charman & Baird, 2002). These findings have implications for early screening and diagnosis in very young children.
Early identification of autism is clearly important but is not an end in itself. How we respond to very young children with autism and their families is critical. Early identification is only useful if followed up by access to early intervention programmes, parent education and support and a range of health, education and welfare services for the child and his/her family.
What to look for in the first year of life:
Lack of social smile
What additional things to look for in the two year old:
Charman, T & Baird, G. (2002). Practitioner Review: Diagnosis of autism spectrum disorder in 2- and 3- year old children. J. Psychology and Psychiatry, 43, 289-305.
Gray, K & Tonge, B. (2001). Review article. Are there early features of autism in infants and preschool children? J. Paediatr. Child Health, 37, 221-226.
Zwaigenbaum, L. (2001). Autistic spectrum disorders in preschool children. Canadian Family Physician, 47, 2037-2042.