Communication challenges often offer clues
Typically, babies babble and toddlers chatter. But a child with autism spectrum disorder may lack these — and other — communication skills.
Allie Wainer, PhD, a clinical psychologist who specializes in autism spectrum disorder at Rush's Autism Assessment, Research, Treatment and Services (AARTS) Center, notes that signs of autism can be observed in the first years of life for many children.
“As we learn more about early behavioral markers of autism, we are able to identify and diagnose autism, and treat core symptoms, in children as young as 12 or 18 months old,” Wainer says.
Wainer describes some of the common early communication and socialization markers that might signal autism:
Early communication delays
By the time children are 18 months old, they often are saying a handful of words. But children with autism might not say any words or “might only repeat back what they hear others say but not use language on their own,” Wainer says.
Wainer notes that a child can have language and communication delays and not have autism. But kids who have communication delays without autism develop other strategies to try to communicate their needs, such as eye contact or gestures.
“Young children tend to say a lot with their facial expressions, eye contact and body language, even if they aren’t yet using words,” she says.
For children with autism, though, those attempts to compensate are usually not present.
“Most young children also turn in response to hearing their name called or hearing the voices of familiar people,” Wainer says. But children with autism often don’t turn or look up when they hear their name called, and parents are sometimes left wondering if there might be something wrong with their child’s hearing. Children with autism might also have a hard time following directions or understanding questions.
Children with autism who do speak may parrot what you say — often with the same tone — which is called echolalia. For instance, Wainer says, “I might ask a child, ‘Do you want to color?’ And instead of saying, ‘I want to color,’ she would say, ‘Do you want to color?’”
Another common example is a child who might repeat a line they like from a movie or book over and over again. The phrase will often be out of context, like a script that is stuck in a child’s head.
Limited sharing of interest
Children with autism are less likely to gesture or point toward something interesting to show it to another person.
“Young children spend a lot of time pointing out exciting and interesting things in their world. They might point to loud airplanes in the sky or their favorite animal at the zoo. They want you to see what they see,” Wainer says. Children with autism, though, are less likely to draw others into their world in this way and may be more content exploring the world on their own.
Subtle troubles with social exchange
Some children with autism don’t have problems with basic language skills. But they struggle with communication in other ways.
For instance, it might be difficult to interrupt them when they talk. Or they may want to talk only about certain topics or have a hard time carrying on a conversation. “They might answer direct questions well,” Wainer says. “But it might be challenging for them to respond to more open-ended questions like ‘why don’t you tell me about school today?’”
Parents: Trust your feelings
There is quite a bit of variation in how kids develop, so if a child has one or two of these issues, it might not mean anything, Wainer notes. But it’s important for parents to talk to their pediatrician as soon as they do have concerns.
“Parents know their children better than anyone else. It is so important that they voice their concerns and let doctors and educators know what they are seeing at home,” Wainer says. “We know that earlier intervention is associated with improved outcomes, so the sooner families can get help, the better it is for everyone in the long term.”
“It’s also OK to ask for additional opinions if you’re told not to worry and you’re worried,” Wainer notes. At Rush’s Autism Assessment, Research, Treatment and Services (AARTS) Center, parents receive a comprehensive evaluation of their child and multiple treatment options, and specialists at the center frequently provide second (and even third) opinions.
“We are very aware that young children with autism turn into adults with autism,” Wainer says. “It isn’t enough to just think about a child’s immediate needs. We are also thinking about their and their family’s needs in one year, five years and 10 years.” Wainer notes that through an active clinic research program and several outpatient clinics, “the AARTS center is devoted to supporting individuals with autism for their entire lifespan.”