Robert Dabrow, MD, FAAP
Watching a young child grow is a wonderful and unique experience for all parents. Seeing your child learn to sit up, walk, and talk are some of the major developmental milestones achieved in the first 2 years. At every well exam your child will be evaluated for appropriate developmental milestones. Observations of normal development are also part of every illness visit. Often, it may seem like we are playing with your child, but we are monitoring their progress for motor, social, and communication skills. At certain exams (9-month, 18-month, 2 year, and 2.5-year exams), you will be asked to answer extended developmental screening questionnaires to provide additional parent observations of your child’s milestones. At the 18-month and 2-year exams, specific autism screening questions are added. Even though every child develops at a different rate, they should be able to do certain things at certain ages. Keep in mind that there may not be a “right” answer to any of the questions, but your responses may be an early indicator of a potential problem.
Autism Spectrum Disorder (ASD) is a neurologically based disability that affects a child’s social skills, communication, and behavior. Autism spectrum is often overlooked by families as a problem until after age 3, but it can be diagnosed in some children as early as age 18 months. ASD may be as common as 3-4 out of every 1000 children, and may be as high as 1 in 150 for boys. Because most children with ASD will master early motor skills such as sitting, crawling, and walking on time, parents may not initially notice delays in social and communication skills. Children with ASD do not follow the typical patterns of child development. In most cases, the problems in communication and social skills become more noticeable as the child falls farther behind other children the same age (sometimes noticed after pre-school entry). Between 12-36 months old, we often see unusual behavior patterns developing and can also see the differences in the way a child reacts to people. Some parents report sudden changes as the child starts to reject people, act strangely, or lose language and social skills they had previously acquired. In other cases, there is a slower loss of previous progress.
Some Communication Indicators of Autism Spectrum Disorders
- Does not babble, point, or make meaningful gestures by 1 year of age
- Does not point to objects or bring objects of personal interest to parents
- Does not speak words by 16 months
- Does not combine two words by 2 years
- Repeats exactly what others say without understanding meaning (parroting)
- Does not respond to their name
- Loses language or social skills
- May have extremely good memory for numbers, letter, songs or jingles with speech delay
Some Social Indicators of Autism Spectrum Disorders
- Poor eye contact or very little eye contact
- Does not seem to know how to play with toys
- Excessively lines up toys or other objects
- Is attached to one particular toy or object exclusively
- Does not smile or respond to parental smiles or facial expressions
- Seems to act like he/she is hearing impaired
- Does not seem to show concern (empathy) for others
- Is unable to make friends or uninterested in making friends
Some Behavioral Indicators of Autism Spectrum Disoder
- Rocks, spins, sways, whirls or flaps hands (stereotypic behaviors)
- Likes routines and rituals and has severe difficulty with change
- Obsessed with few or unusual activities, doing them repeatedly every day
- Plays with parts of toys rather than the whole toy (ex: spins wheels of truck excessively)
- Does not seem to feel pain
- May be extra sensitive or not sensitive at all to smells, sounds, lights, textures, and touch
- Unusual use of vision or gaze – looks at objects from unusual angles
Although parents have many concerns about labeling a young child as having ASD, the earlier the diagnosis is made, the earlier interventions can begin. Early screening and early interventions lead to better outcomes. Your provider will often suggest referrals for further evaluation when the child is just “a little slow” or “a little behind”. Evidence over the last 20 years suggests that early intervention in optimal educational settings for at least 2 years during the preschool years results in improved outcomes in most children with ASD.
As soon as a child’s developmental delay has been identified, instruction and therapy should begin. Effective programs will teach early communication and social interaction skills. These interventions target specific deficits in learning, language, imitation, attention, motivation, and compliance. Therapies often include a variety of behavioral therapies, communication (speech and language) therapy, occupational therapy, and physical therapy along with social interventions. Parents are necessary partners with teachers and therapists, and they can continue many of the therapies at home.
In children younger than 3 years, appropriate interventions usually take place in the home or at a childcare center. An additional referral to the Early Steps program may be initiated. For children older than age 3 who are enrolled in public pre-school or VPK, they can request an evaluation for an IEP or 504 plan. Some schools provide additional services such as speech therapy and occupational therapy.
If you have any concerns about your child’s development, please discuss these with us at your child’s preventative health (well) exam. If you would like to monitor your child’s current developmental progress, go to www.cdc.gov/MilestoneTracker and download the app.