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Raising children

Understanding Autism Spectrum Disorder

Timely identification of autism spectrum disorder (ASD) is essential for effective intervention.

Professional Evaluation

It is essential to seek professional evaluation when assessing the risk of Autism Spectrum Disorder (ASD) in a child. Professionals have the expertise and experience to accurately evaluate and diagnose ASD.

If you have concerns about your child between the ages of 12-36 months and are located in the San Diego area, don’t hesitate to contact the ACE Center for a comprehensive evaluation. You can reach us at 858-534-6912 to schedule an appointment and get the support and guidance you need.

Early Warning Signs

Communication

Children who are at risk for autism might demonstrate peculiar vocalizations that lack tonal variation.

  • Example in a Typical Scenario: Mrs. Smith hears Johnny babble in his crib, resembling a conversation in an unfamiliar language.
  • Example Showing Autism Risk: Mrs. Jones notices Sam making monotonous humming and whining sounds.

References:

  • Brisson, J. (2014). Acoustic analysis of infants later diagnosed with autism. Infant Mental Health Journal, 35(3), 285-295.
  • Sheinkopf, Mundy, Oller, & Steffens (2000). Vocal atypicalities in preverbal autistic children. Journal of Autism and Developmental Disorders, 30(4):345-354.

Unusual Reactions

Children at risk for autism might display unusual reactions to sounds, textures, and tastes.

  • Example in a Typical Scenario: Mrs. Smith observes Johnny trying various foods but avoiding vegetables.
  • Example Showing Autism Risk: Mrs. Jones notices Sam rejecting solid foods and getting upset, preferring baby food and a bottle.

References:

  • Ausderau, K., et al. (2014). Sensory features in children with ASD. Journal of Autism and Developmental Disorders, 44(4), 915–925.
  • Kirby, A., et al. (2015). Observational characterization of sensory behaviors. The American Journal of Occupational Therapy, 69(3), 9
  • Children with autism may have heightened or diminished sensitivity to sensory stimuli, leading to aversions or preferences for certain sounds, textures, and tastes.
  • Parents and caregivers should take note of these unusual reactions as they may indicate a potential risk for autism spectrum disorder.

Object Attachment

Children at risk for autism may form strong attachments to specific objects.

  • Example in a Typical Scenario: Mrs. Smith ensures Johnny has his teddy bear for comfort at bedtime.
  • Example Showing Autism Risk: Mrs. Jones allows Sam to keep her keys with him at bedtime as they provide comfort.
  • Additional Information: Object attachment in children with autism may manifest as a reliance on certain objects for comfort or security. This behavior can be a coping mechanism for managing anxiety or sensory overload.

References:

  • Harrop, C., Gulsrud, A., Shih, W., Hovsepyan, L., & Kasari, C. (2016). Caregiver responses to behaviors in toddlers with autism. Autism, 20(3), 330–342.
  • Richler, Bishop, Kleinke, & Lord (2007). Repetitive behaviors in young children with autism. Journal of Autism and Developmental Disorders. (37):73-85.

Repetitive Movements

Children at risk for autism might engage in repetitive and unconventional body movements.

  • Example in a Typical Scenario: Mrs. Smith notices Johnny’s unique way of throwing a ball.
  • Example Showing Autism Risk: Mrs. Jones observes Sam repeating a specific movement after throwing a ball.

References:

  • Damiano, C., et al. (2013). Repetitive movements in infant siblings of children with autism. Journal of Autism and Developmental Disorders, 43(6), 1326-35.
  • D’Mello, A., & Stoodley, C. (2015). Cerebro-cerebellar circuits in autism. Frontiers in Neuroscience, 9, 408-408.

Atypical Object Usage

Children at risk for autism may utilize objects in non-traditional ways.

  • Example in a Typical Scenario: Mrs. Smith observes Johnny playing with a toy car and mimicking engine sounds.
  • Example Showing Autism Risk: Mrs. Jones witnesses Sam repeatedly spinning the wheels of a toy car close to his face.

References:

  • Campbell, S., et al. (2016). Pretend play in toddlers at risk for autism. Journal of Autism and Developmental Disorders, 46(7), 2305-16.
  • Ozonoff, Macari, Young, et al. (2008). Object exploration and autism risk. Autism, 12(5), 457-472.

Children at risk for autism may exhibit frequent crying or tantrums, which could be triggered by unknown causes and prove resistant to typical soothing techniques.

  • Example in a typically developing child: Mrs. Smith comforts Johnny after a minor mishap, and he quickly calms down to resume his activities.
  • Example in a child at risk for autism: Mrs. Jones struggles to soothe Sam, whose crying appears unexplained and hard to manage.

Scientific References:

  • Konst, M., Matson, J., & Turygin, N. (2013). Correlation between autism symptoms and tantrums. Research in Autism Spectrum Disorders, 7(9), 1068-1074.
  • Mayes, S., Lockridge, R., & Tierney, C. (2017). Tantrums in preschool children with autism. Journal of Developmental and Physical Disabilities, 29(4), 587-596.
  • Garon, Bryson, Zwaigenbaum, Smith, Brian, Roberts, & Szatmari (2009). Temperament and autistic symptoms in at-risk infants. Journal of Abnormal Child Psychology, 37:59-78.
  • Wetherby, Woods, Allen, Cleary, Dickinson, & Lord (2004) Early signs of autism spectrum disorders in toddlers. Journal of Autism and Developmental Disorders, 34(5): 473-493.

Show low enthusiasm to explore new things or appear underactive

A child at risk for autism may demonstrate disinterest in new toys, people, or environments.

  • Example in a typically developing child: Mrs. Smith watches Johnny explore a park, finding delight in various play structures.
  • Example in a child at risk for autism: Mrs. Jones observes Sam fixated in one spot, unwilling to engage with different play structures.

Scientific References:

  • Kaur, M., Srinivasan, S., & Bhat, A. (2015). Object exploration in infants at risk for autism. Frontiers in Psychology, 6, 798-798.
  • Little, L., Ausderau, K., Sideris, J., & Baranek, G. (2015). Activity in autistic children. Journal of Autism and Developmental Disorders, 45(9), 2981-2990.
  • Ozonoff, Macari, Young, Goldring, Thompson, & Rogers (2008). Object exploration and autism. Autism, 12(5), 457-472.
  • Pierce & Courchesne (2001) Role of the cerebellum in autism behavior. Biological Psychiatry, 49(8), 655-64.

Toddlers between 12–24 months
at risk for an Autism Spectrum Disorder might not.

Point at things

A child at risk for autism may struggle to point at distant objects, failing to direct attention to their surroundings.

  • Example in a typically developing child: Mrs. Smith notices Johnny pointing at an airplane flying overhead during their walk.
  • Example in a child at risk for autism: Mrs. Jones takes Sam for a walk, but he does not interact with or point at passing airplanes.

Scientific References:

  • Talbott, M., Young, G., Vismara, L., Rogers, S., Munson, J., & Estes, A. (2018). Gesture and language in toddlers with autism. Child Development.
  • Gordon, R., & Watson, L. (2015). Gestures in children at risk for autism. Journal of Autism and Developmental Disorders, 45(7), 2267-2273.
  • Vostanis, Smith, Corbett, Sungum-Paliwal, Edwards, Gingell, Golding, Moore, & Williams (1998). Early development concerns in children with autism. Autism, 2, 229-242.
  • Baron-Cohen, Cox, Baird, Swettenham, Nightingale, Morgan, Drew, & Charman (1992). Early psychological markers of autism detection in infants. British Journal of Psychiatry, 168, 158-163.

Babble or talk back and forth with another person

Children at risk for autism may encounter challenges in vocalizing meaningfully or generating typical babbling sounds.

  • Example in a typically developing child: Johnny engages and vocalizes during mealtime with Mrs. Smith.
  • Example in a child at risk for autism: Sam remains unresponsive, emitting high-pitched noises while being fed by Mrs. Jones.

Scientific References:

  • Garrido, D., Watson, L., Carballo, G., Garcia-Retamero, R., & Crais, E. (2017). Vocal patterns in infants at risk for autism. Autism Research: Official Journal of the International Society for Autism Research, 10(8), 1372-1383.
  • Patten, E., Belardi, K., Baranek, G.T. et al. (2014). Vocal patterns in children with autism. Journal of Autism and Developmental Disorders, 44, 2413–2428.
  • Landa, Holman, & Garrett-Mayer (2007). Social development in toddlers with autism spectrum disorders. Archives of General Psychiatry, 64, 853-864.
  • Werner, Dawson, Osterling, & Dinno (2000). Early recognition of autism spectrum disorder. Journal of Autism and Developmental Disorders, 30, 157-162.

Try to gain the attention of others

A child at risk for autism may not reciprocate smiles or laughter in response to interactions, despite displaying happiness independently.

  • Example in a typically developing child: Johnny responds with smiles while playing with his mother, Mrs. Smith.
  • Example in a child at risk for autism: Sam smiles only when tickled by Mrs. Jones.

Scientific References:

  • DeQuinzio, J., Poulson, C., Townsend, D., & Taylor, B. (2016). Social referencing in children with autism. The Behavior Analyst, 39(2), 319-331
  • Nichols, C., Ibañez, L., Foss-Feig, J., & Stone, W. (2014). Social smiling in high-risk infants without later ASD symptoms. Journal of Autism and Developmental Disorders, 44(4), 894-902.
  • Zwaigenbaum, Bryson, Rogers, Roberts, Brian, & Szatmari (2005) Autism behaviors in the first year. International Journal of Developmental Neuroscience, 23, 143-152.
  • Lord, Pickles, McLennan, Rutter, Bregman, Folstein, Fombonne, Libya, & Minshew (1997). Autism Diagnosis Research: Examination of Data from the Autism Diagnostic Interview. Journal of Autism and Developmental Disorders, 27, 501-517.

Smile in response to your smile

A child showing potential signs of autism may not exhibit smiles or laughter in response to social interactions, despite appearing content by themselves.

  • Example of a typical child: Johnny smiles in response to interactions with his mother, Mrs. Smith.
  • Example of a child at risk for autism: Sam only smiles when tickled by Mrs. Jones.

References:

  • DeQuinzio, J., Poulson, C., Townsend, D., & Taylor, B. (2016). Social Referencing in Children with Autism. The Behavior Analyst, 39(2), 319-331
  • Nichols, C., Ibañez, L., Foss-Feig, J., & Stone, W. (2014). Social Smiling in High-Risk Infants Without Later Autism Symptoms. Journal of Autism and Developmental Disorders, 44(4), 894-902.
  • Zwaigenbaum, Bryson, Rogers, Roberts, Brian, & Szatmari (2005) Early Behavioral Signs of Autism. International Journal of Developmental Neuroscience, 23, 143-152.
  • Lord, Pickles, McLennan, Rutter, Bregman, Folstein, Fombonne, Libya, & Minshew (1997). Autism Diagnosis Research: Examination of Data from the Autism Diagnostic Interview. Journal of Autism and Developmental Disorders, 27, 501-517.

Make good eye contact

A child at risk for autism may not engage in appropriate eye contact for social interaction. Some children with autism may still maintain some level of eye contact.

  • Example of a typical child: Johnny makes eye contact when making requests to Mrs. Smith.
  • Example of a child at risk for autism: Sam avoids eye contact with Mrs. Jones.

Why is good eye contact important:
Engaging in good eye contact is an essential part of social interaction. It helps in establishing connections, showing interest, and understanding emotions. For individuals with autism, practicing and improving eye contact can aid in better communication and social skills development.

How to encourage good eye contact:
– Practice activities that involve making eye contact, such as playing games or reading stories.
– Use visual aids or prompts to remind the child to maintain eye contact during conversations.
– Provide positive reinforcement and praise when the child makes efforts to maintain eye contact.

References:

  • Gangi, D., Schwichtenberg, A., Iosif, A., Young, G., Baguio, F., & Ozonoff, S. (2018). Gaze Behavior in Infants at High Risk for Autism. Autism : The International Journal of Research and Practice, 22(6), 763-768.
  • Jones, W., & Klin, A. (2013). Decline in Attention to Eyes in Infants Later Diagnosed with Autism. Nature, 504(7480), 427-31.
  • Wetherby, Woods, Allen, Cleary, Dickinson, & Lord (2004). Early Indicators of Autism Spectrum Disorders in Infants. Journal of Autism and Developmental Disorders, 34, 473-493.
  • Zwaigenbaum, Bryson, Rogers, Roberts, Brian, & Szatmari (2005). Early Behavioral Signs of Autism. International Journal of Developmental Neuroscience, 23, 143-152.

Additional information:
Children at risk for autism may also show difficulties in understanding the concept of joint attention, which is the ability to share attention with others towards an object or event. This can impact their language development and social interactions.
Research studies have shown that early behavioral signs of autism, such as difficulties in sharing objects with others, can be detected in infancy. Parents’ concerns about their child’s early development, including their communication and social skills, can also be an important indicator for autism screening.
It is important for parents and caregivers to be aware of these early signs and seek early intervention services if they have concerns about their child’s development. Early identification and intervention can lead to better outcomes for children with autism spectrum disorder.
References:
– Bruyneel, E., Demurie, E., Warreyn, P., & Roeyers, H. (2019). Joint Attention Impact on Language Development in Siblings at Risk for Autism. Infant Behavior and Development, 57.
– Dow, D., Day, T., Kutta, T., Nottke, C., & Wetherby, A. (2020). Autism Spectrum Disorder Screening at Home. Autism Research: Official Journal of the International Society for Autism Research, 13(1), 122-133.
– Zwaigenbaum, Bryson, Rogers, Roberts, Brian, & Szatmari (2005). Early Behavioral Signs of Autism. International Journal of Developmental Neuroscience, 23, 143-152.
– Vostanis, Smith, Corbett, Sungum-Paliwal, Edwards, Gingell, Golding, Moore, & Williams (1998). Parental Concerns about Early Development in Autism. Autism – The International Journal of Research and Practice, 2, 229-242.

Point to request

A child at risk for autism may not use pointing as a means to convey preferences or desires.

  • Example of a typical child: Johnny points to show his preference for a snack.
  • Example of a child at risk for autism: Sam reaches for the snack without indicating his preference.
  • Additional information: In addition to pointing, joint attention behaviors such as following pointing gestures and sharing attention with others are also often reduced in infants at risk for autism. These behaviors play a crucial role in social communication and interaction development.

References:

  • Franchini, M., et al. (2019). Joint Attention Behaviors in Infants at Risk for Autism. Journal of Abnormal Child Psychology : An Official Publication of the International Society for Research in Child and Adolescent Psychopathology, 47(5), 907-920.
  • Sansavini, A., Guarini, A., Zuccarini, M., Lee, J., Faldella, G., & Iverson, J. (2019). Less Pointing in Infants at Risk for Autism. Frontiers in Psychology, 10, 2131-2131.
  • Vostanis, Smith, Corbett, Sungum-Paliwal, Edwards, Gingell, Golding, Moore, & Williams (1998). Parental Concerns about Early Development in Autism. Autism – The International Journal of Research and Practice, 2, 229-242.
  • Baron-Cohen, Cox, Baird, Swettenham, Nightingale, Morgan, Drew, & Charman (1992). Early Markers of Autism Detection in Infants. British Journal of Psychiatry, 168, 158-163.

Respond to their name

Respond to their name

A child at risk for autism may not respond to their name being called despite repeated attempts to gain their attention.

  • Example of a typical child: Johnny turns towards Mrs. Smith when called multiple times.
  • Example of a child at risk for autism: Sam does not acknowledge Mrs. Jones calling his name or making noises.

References:

  • Miller, M., Iosif, A., Hill, M., Young, G., Schwichtenberg, A., & Ozonoff, S. (2017). Name Response in Infants Developing Autism. The Journal of Pediatrics, 183, 141-146.
  • Zhang, D., et al. (2018). Name Response as an Early Detection Tool for Developmental Disorders. Research in Developmental Disabilities, 82, 95-108.
  • Luyster, Gotham, Guthrie, Coffing, Petrak, Pierce, Bishop, Esler, Hus, Oti, Richler, Risi, & Lord (2009). Observation of Autism in Toddlers. Journal of Autism and Developmental Disorders, 39, 1305-1320.
  • Werner, Dawson, Osterling, & Dinno (2000). Recognition of Autism in Infancy. Journal of Autism and Developmental Disorders, 30, 157-162.

Look when you try to direct their attention

A child at risk for autism may not follow another person’s gaze to shift their attention.

  • Example of a typical child: Johnny gazes at an object after noticing Mrs. Smith look in that direction.
  • Example of a child at risk for autism: Sam does not follow Mrs. Jones’ gaze, even when prompted to shift his attention.

References:

  • Del Bianco, T., Falck-Ytter, T., Thorup, E., & Gredebäck, G. (2019). Development of Gaze-Following in Infants. Infancy, 24(3), 433-454.
  • Helminen, T., Leppänen, J., Eriksson, K., Luoma, A., Hietanen, J., & Kylliäinen, A. (2017). Atypical Response to Direct Gaze in Children with Autism.
  • Luyster, Gotham, Guthrie, Coffing, Petrak, Pierce, Bishop, Esler, Hus, Oti, Richler, Risi, & Lord (2009). Observation of Autism in Toddlers: A New Diagnostic Module for Autism Spectrum Disorders.

Enjoy cuddling

A child at risk for autism may not seek out or enjoy cuddling regularly, although they might occasionally derive some pleasure from it.

  • Example of a typical child: Johnny seeks cuddles and prefers physical affection during bedtime.
  • Example of a child at risk for autism: Sam resists cuddling, only seeking contact when distressed or unwell.

References:

  • Fabio, A., Natasha, C., Valeria, C., Sara, B., Lucia, B., David, C., & Filippo, M. (2013). Interaction Reciprocity in Infants at Risk for Autism. Autism Research and Treatment, 2013.
  • Kadlaskar, G., Seidl, A., Tager-Flusberg, H., Nelson, C., & Keehn, B. (2019). Responses to Caregiver Touch in Infants at High Risk for Autism. Journal of Autism and Developmental Disorders, 49(7), 2946-2955.
  • Vostanis, Smith, Corbett, Sungum-Paliwal, Edwards, Gingell, Golding, Moore, & Williams (1998). Parental Concerns about Early Development in Autism. Autism – The International Journal of Research and Practice, 2, 229-242.

Show shared enjoyment

A child at risk for autism may display limited or absent expressions of pleasure during social interactions.

  • Example of a typical child: Engages in play with smiles and laughter.

    • Children who are at risk for autism may exhibit a lack of interest in playing with others or engaging in social interactions. For example, while a typically developing child like Johnny easily joins in games with peers, a child at risk for autism such as Sam may prefer solitary play and avoid interaction with others.
    Scientific research backs up these observations. Studies have shown that children with autism spectrum disorder may struggle with theory of mind, affecting their ability to understand and engage in social interactions. Additionally, temperamental markers in toddlers with autism spectrum disorder have been identified, shedding light on the early signs of the condition.
    Furthermore, children at risk for autism may have limited facial expressions, particularly when expressing emotions. While a child like Johnny can easily show surprise with facial expressions, a child at risk for autism like Sam may exhibit a lack of facial expressions in response to emotional stimuli.
    In conclusion, recognizing these early signs and behaviors in children can help with timely screening and intervention, leading to better outcomes for those at risk for autism spectrum disorder.