Early signs and symptoms of ASD — The what & how

Autism & Autism spectrum disorders - These terms are used quite commonly and interchangeably by parents & professionals to represent a group of neurodevelopmental disorders characterized by difficulty in social interaction & communication & repetitive patterns of thoughts & behavior.

Although this is the meaning of autism, this term is often highly misunderstood and there are a lot of misconceptions.

So, in this article, I will be giving a brief idea about:-

what is autism, the common features, and some early signs & symptoms that might help you identify children with ASD & help them reach out for early intervention as early as possible.

What is Autism?

It is a neurodevelopmental disorder characterized by these 3 features:-

1. Difficulty in social interaction
2. Difficulty in verbal & nonverbal communication &
3. Repetitive/restricted patterns of thoughts & behavior.

It usually appears before 3 years of age.

Autism comes under Autism spectrum disorder- which is a spectrum that includes- Autism, Pervasive developmental disorders not otherwise specified, and Asperger's syndrome.

What is ASD ?

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication, and behavioral challenges.

A diagnosis of ASD now includes several conditions that used to be diagnosed separately : autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder.

Why is it important to identify the signs in children with ASD ?

There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged.

Since kids under ASD appear like their normal peers, its likely that they remain undiagnosed until a certain age when the features are hard to ignore. This often hampers their progression as they have lost some precious years due to lack of awareness regarding their child’s condition.

Therefore, it's important for all of us to be aware and spread this awareness so that these kids can get the proper intervention from an early stage.

Incidence of ASD

Autism spectrum disorder (ASD) is globally a major cause of childhood disability. It is estimated that worldwide about one in 270 people has an ASD.

About 1 in 100 children in India under age 10 have autism, and nearly 1 in 8 has at least one neurodevelopmental condition.

It is more common in boys than in girls. ( Boys are 5 times more affected than girls )

Early diagnosis is an important criterion to start early interventions for ASD treatment.

What causes autism or autism spectrum disorders?

Although the exact causes of autism have not been very clear yet, it is accepted that there are abnormalities in the brain structure & function causing disruption in the normal processing of various sensory inputs. The abnormalities might be due to the following causes:-

• having an immediate family member with autism.
• genetic mutations.
• fragile X syndrome and other genetic disorders.
• being born to older parents.
• low birth weight.
• metabolic imbalances.
• exposure to heavy metals and environmental toxins.
• a history of viral infections
• The rate of prevalence of autism is more these days due to excessive exposure to mobiles (electromagnetic waves)

Red flag signs for autism ( seen in 6-12 months babies)

1. Rarely smiles when approached by caregivers
2. Rarely tries to imitate sounds and movements others make, such as smiling and laughing, during simple social exchanges
3. Delayed or infrequent babbling
4. Does not respond to his or her name with increasing consistency from 6–12 months
5. Does not gesture to communicate by 10 months
6. Poor eye contact
7. Seeks your attention infrequently
8. Repeatedly stiffens arms, hands, legs or displays unusual body movements such as rotating the hands on the wrists, uncommon postures, or other repetitive behaviors
9. Does not reach up toward you when you reach to pick him or her up
10. Delays in motor development, including delayed rolling over, pushing up, and crawling.

If parents suspect something is wrong with their child’s development, or that their child is losing skills, they should talk to their pediatrician or another developmental expert.

“Don’t adopt a ‘wait and see’ perspective. We want to identify delays early in development so that intervention can begin when children’s brains are more malleable and still developing their circuitry.”

Parents complaints / Signs & symptoms observed by parents:-

* Social communication and interaction

A child or adult with autism spectrum disorder may have problems with social interaction and communication skills, including any of these signs:

• Fails to respond to his or her name or appears not to hear you at times
• Resists cuddling and holding, and seems to prefer playing alone, retreating into his or her own world
• Has poor eye contact and lacks facial expression
• Doesn’t speak or has delayed speech, or loses previous ability to say words or sentences
• Can’t start a conversation or keep one going, or only starts one to make requests or label items
• Speaks with an abnormal tone or rhythm and may use a singsong voice or robot-like speech
• Repeats words or phrases verbally, but doesn’t understand how to use them in daily life while interacting with someone.
• Doesn’t appear to understand simple questions or directions
• Doesn’t express emotions or feelings and appears unaware of others’ feelings
• Appear to be unaware when people talk to them, but respond to other sounds
• Can be very interested in people, but not know how to talk, play, or relate to them
• Lose skills they once had (for example, stop saying words they were using)
• Doesn’t point at object to show interest (for example, not point at an airplane flying over .
• Inappropriately approaches a social interaction by being passive, aggressive or disruptive
• Has difficulty recognizing nonverbal cues, such as interpreting other people’s facial expressions, body postures or tone of voice.

* Patterns of behavior

A child or adult with autism spectrum disorder may have limited, repetitive patterns of behavior, interests or activities, including any of these signs:

• Performs repetitive movements, such as rocking, spinning or hand flapping
• Produces repetitive and meaningless sounds like humming, squealing, throat clearing,etc.
• Performs activities that could cause self-harm, such as biting or head-banging
• Develops specific routines or rituals and becomes disturbed at the slightest change
• Has problems with coordination or has odd movement patterns, such as clumsiness or walking on toes.
• Is fascinated by details of an object, such as the spinning wheels of a toy car, but doesn’t understand the overall purpose or function of the object
• Is unusually sensitive to light, sound or touch, yet may be indifferent to pain or temperature
• Doesn’t engage in imitative or make-believe play
• Fixates on an object or activity with abnormal intensity or focus
• Has specific food preferences, such as eating only a few foods, or refusing foods

The symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. Although autism is defined by a certain set of behaviors, children and adults can exhibit any combination of the behaviors in any degree of severity. Two children, both with the same diagnosis, can act very differently from one another and have varying skills.

The Positive side ( abilities of children with ASD)

As I told earlier, some kids in the spectrum are gifted in a particular area, here are some of the extraordinary abilities found in kids with ASD.

• High IQ level
• Learning to read at a very early age (known as hyperlexia).
• Memorising and learning information
• Exceptionally strong visual memory( Once they see something, they remember it in precise details).
• Logical thinking ability.
• May excel (if able) in academic areas such as science, engineering and mathematics as they are technical and logical subjects that do not heavily rely on social interaction.
• Having an extraordinarily good memory (being able to remember facts for a long period of time).
• Being precise and detail orientated.
• Having an excellent sense of direction.
• Be very punctual.
• Strong adherence to rules.
• Able to concentrate for long periods of time when motivated.
• A drive for perfection and order.
• Productive in a single context ( some might be exceptionally talented in art or music or any sports )

If we focus on a child’s abilities instead of disabilities and nurture his/her skills with proper guidance, we can help them to succeed tremendously in that area.

Diagnosis

Diagnosing ASD can be difficult since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis.

If your child shows any symptoms of autism spectrum disorder, you’ll likely be referred to a specialist who treats children with autism spectrum disorder, such as a child psychiatrist or psychologist, pediatric neurologist, or developmental pediatrician, for an evaluation. After a formal diagnosis, they will refer to professionals like occupational therapist, speech therapist who are specialized for the in-depth assessment & intervention planning.

Its important for parents to become good observers of their children’s development so that they can see the earliest indicators of delays in a baby’s communication, social and motor skills. Yet, some children who develop ASD don’t show signs until after the second birthday or regress after appearing to develop typically.

Whom to approach after a child is diagnosed to be under ASD

Children under ASD have a variety of issues in different areas. So, the intervention requires a team approach that includes:-

1. Occupational therapist
2. Speech therapist
3. Special educator
4. Psychologist
5. Dietician

Role of these professionals in the intervention

Even though a formal diagnosis is important for referral, its much more important to know which particular areas (sensory systems) are affected, to plan an appropriate treatment program.

Occupational therapists are specialized in sensory integration. They use a number of tools like questionnaires, parent interviews, observation, and various standardized & non-standardized tools to assess in detail which particular areas are affected and plan an intervention program appropriate for the child’s age and abilities.

By assessing each child’s sensory profile , based on the requirement, they plan a variety of activities and adaptations which helps the individuals in maintaining an appropriate level of arousal essential for his/her performance in the society, to become independent in his daily tasks, to become more confident to interact with the society.

The other professionals along with an occupational therapist work to help your child integrate with the normal society, to become independent in all his daily tasks, academics, verbal & non verbal communication, expressing needs, etc.

Kids improvements depends on:-

•Early identification

•Proper awareness about the condition and understanding the child.

•Parents support and family members cooperation

•Fixing a short term goal noticing small positive changes in the kids and appreciating it

•Accept and appreciate child’s performances, respect child’s “no”

•Initial focus on self independence, improving basic cognitive skills, language, social and academic skills.

•Give private time for kids and yourself

• Don’t mind about others/ public

•Don’t compare with other children

•Quality of therapy matters than quantity

• Therapy is based on the child’s interest and active participation. Knowing when to push forward and stop and try another day.

Lastly, I would say that, although a diagnosis of autism can be very scary for a parent, don't let a diagnosis stop you or your child from living a beautiful life. Among all that pain, there can be joy and satisfaction too. Appreciate the little changes in your child. When you appreciate the small improvements, it will produce great changes with time.

Focus on his/her abilities, they can have some extraordinary abilities. Get creative in your ways of teaching. Take the help of your child’s therapist whenever you have any difficulty. The ride can be as fun as you make it to be !

I hope this article will be very useful to spread awareness about autism.

Hope you enjoyed reading it !

About the writer :-

The writer’s name is Abhipsa Parida. She is an occupational therapist specialised in pediatrics and has been handling kids with special needs since 5 years. She is quite experienced and skillful in observation, assessment and planning intervention for kids with special needs. She uses evidence based practice and is very creative and updated in her approach while handling kids with special needs. She has her own clinic in Bhubaneswar and has handled many kids of different age groups with varying needs.

If you have any queries, you can mail them at abhipsaot21@gmail.