Children with autism generally have problems in three crucial areas of development — social interaction, communication and behavior. But autism symptoms vary greatly and two children with the same diagnosis may behave quite differently. In most cases, severe autism is marked by a complete inability to communicate and interact with other people.
The onset of symptoms, regardless of the age of diagnosis, is prior to 3 years of age. Some children show signs of autism in early infancy. Other children may develop normally for the first few months or years of life but then suddenly become withdrawn, become aggressive or lose language skills they’ve already acquired.
Autism varies widely and symptoms and may go unrecognized, especially in mildly affected children or when more debilitating handicaps hide the symptoms. All children should have routine developmental exams done by their pediatrician. Further testing may be needed if the doctor or parents are concerned. These children might receive a hearing evaluation, blood lead test, and thyroid tests along with a screening test for autism (such as the Checklist for Autism in Toddlers [CHAT] or the Autism Screening Questionnaire).
Very early indicators that should be evaluated by a doctor include:
3 months: no response to loud noises, no notice of hand movements, eyes do not follow a moving object, no smiling at people.
Later indicators include:
Health care providers often use a questionnaire to gather information about a child’s development and behavior. Some rely solely on parent observations, while others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of an ASD, a more comprehensive evaluation should be done.
A health care provider experienced in diagnosing and treating autism is usually needed to make the actual diagnosis. Because there is no biological test for autism, the diagnosis will often be based on very specific criteria from a book called the Diagnostic and Statistical Manual IV.
A comprehensive evaluation requires a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for an ASD, children should also have their hearing tested.
Parents also report such things as: appearing not to hear them at times; resistance to cuddling and holding; appearing unaware of others’ feelings; preferring to play alone — retreating into his or her “own world”; not making eye contact when making requests;
speaking with an abnormal tone or rhythm — may use a singsong voice or robot-like speech; repeating words or phrases verbatim, but not understanding how to use them.
Abnormal behaviors may include: performing repetitive movements, such as rocking, spinning or hand-flapping; self-abuse such as biting or head-banging; becoming disturbed at the slightest change in routines or rituals; constant movement; fascination with parts of an object, such as the spinning wheels of a toy car; unusually sensitive to light, sound and touch and yet oblivious to pain.
Young children with autism also have a hard time sharing experiences with others. When being read a story, for example, they are unlikely to point at pictures in the book. As they mature, some children with autism become more engaged with others and show less marked disturbances in behavior. Some children with less severe problems eventually may lead normal or near-normal lives. Many others, however, continue to have difficulty with language or social skills, and behavior problems can worsen in adolescence.
Most children with autism are slow to learn new things, and some have signs of lower than normal intelligence. But some children with autism have normal to high intelligence and learn quickly yet have trouble communicating and adjusting in everyday life. A small number of children with autism have exceptional skills in a specific area, such as art, math or music and are sometimes referred to as “autistic savants”.
Babies develop at their own pace and may not follow the exact time lines found in some parenting books. But children with autism usually show some signs of delayed development by 18 months. If you suspect that your child may not be developing normally, discuss your concerns with your doctor. The earlier a diagnosis is made, the earlier appropriate treatment can begin and the more effective it will be.
Children with some symptoms of autism but not enough to be diagnosed with classical autism may be diagnosed with pervasive developmental disorder – not otherwise specified (PDD-NOS). Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Much rarer are children who may be diagnosed with childhood disintegrative disorder, in which they develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors.
An autism diagnosis is based on observation and testing by a health professional using one or more standardized tests. This testing may be done by psychologists, psychiatrists, developmental pediatricians, or school psychologists. Some of the screenings and tests used in diagnosis are: Childhood Autism Rating Scale (CARS), Autism Diagnostic Checklist, Checklist for Autism in Toddlers (CHAT), Modified Checklist for Autism in Toddlers (M-CHAT), Pervasive Developmental Disorders Screening Test, Autism Diagnostic Observation Scale (ADOS), and Autism Diagnostic Interview – Revised (ADI-R).
Sometimes people are reluctant to have a child diagnosed because of concerns about labeling the child. However, without a diagnosis the child may not get the necessary treatment and services that will help them lead a better life.