World Autism Awareness Day falls on April 2nd and while we are all aware of what ASD (Autism Spectrum Disorder) is, this is a complex disorder with many layers and individual differences. We asked Teresa Ling, a Board Certified Behavior Analyst (BCBA) therapist, to answer some commonly asked questions about ASD.
In simple terms, define autism spectrum disorder (ASD)?
ASD is a developmental disorder that emerges early in life. It is characterised by difficulties with social interaction skills, communication skills, repetitive behaviour, and/or restricted interests. According to the Centers of Disease Control (CDC), autism affects about 1 in 59 children in the United States (approximately 300,000 people in Malaysia live with ASD).
Are there 'levels' of autism and what are they?
There is no distinctive levels of autism, but before we continue, let’s talk about the diagnosis for autism. For a child to be diagnosed with ASD (or other mental disorders), professionals use The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is created by the American Psychiatric Association (APA). The current DSM-5 has grouped different conditions, such as Autism Disorder, Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder, and Asperger Syndrome under a single umbrella of ASD. On top of the re-categorisation of ASD, each individual with ASD may exhibit different levels of severity of impairments. For example, some may need significant support in daily living activities while others may need little to no support. Due to the individual differences in syndrome expression, Autism is known as a ‘Spectrum’ disorder and in that, every individual with ASD is unique.
What is the most common age at which the signs appear or become more obvious?
Generally, symptoms do not show until the child is about 18-24 months old. Studies suggest that at least 80%-90% of parents recognise some atypical behaviours by the age of 24 months. With that being said, studies have found subtle early signs that might be presented even before the age of 18 months. For example, some behaviour (e.g. eye contact, social smiling) shows a gradual decrease in frequency from 6-18 months. Approximately only 20% of parents report having concerns within the first 10 months.
Toddlers undergo rapid growth with regards to social interactions skills, pretend play skills, and verbal and non-verbal communication skills during their second year. This is also when ASD symptoms become more apparent with toddlers showing abnormalities and differences when compared to their typically developing peers, and this when parental concerns are triggered.
What are the signs to look out for in toddlers (pre-school age) with regards to ASD?
Early symptoms of ASD in infants/toddlers at risk:
- Minimum, reduced or avoidance of eye contact (child doesn’t look at speaker’s eyes or may look away if speaker tries to make eye contact)
- Limited social smiling
- Reduced response to name (by 12 months of age)
- Limited initiation of joint attention (doesn’t bring objects over to caregiver or attempt to show caregiver something interesting)
- Minimum or no pointing to communicate needs and express interests (by 14 months of age)
- Atypical preverbal vocalisations (may babble random sounds repeatedly)
- Atypical object exploration (spinning a toy car or lining toy cars up)
- Unusual visual inspection of objects (looks closely at car wheels)
- Inflexible to minor changes (may be upset because the usual water bottle is replaced by a new one)
- Atypical or limited use of nonverbal communication (doesn’t nod or shake the head)
- Deficits in pretend play (by 18 months of age)
- Repetitive motor movements (body rocking, arm waving, ears/hands flapping)
- Minimum, or reduced response to adult social bids (may not be interested in other children or adults, does not react when spoken to by looking, smiling, speaking or babbling)
- Limited response to another person’s distress (doesn’t understand other people’s feelings)
- Atypical response to sensory stimulation like tickling, pain, light, sound, cold or warmth
What is the first thing a parent should do if they think there could be a possibility of their child exhibiting signs?
Consult with the professionals! Talk to your healthcare provider, your child’s paediatrician or developmental psychologist and get a proper assessment and diagnosis. Some may say “Your child will eventually learn how to speak, don’t worry”, or “Your child will respond to you soon, what’s the rush?”. There’s no harm seeking professional advice early on and I strongly encourage parents to do so regardless of what others say.
Early diagnosis is important to help prevent and mitigate some of the symptoms of autism by undergoing early interventions. If you are on a waitlist to see a paediatrician, try out some online Level 1 screening tools, such as Checklist for Autism in Toddlers (CHAT) or Early Screening of Autistic Traits (ESAT). These questionnaires are easy to understand and no training is needed to use them. At the very least, they will give you an idea about whether your child is at risk and eligible for more detailed assessments while you’re waiting to see a professional. It’s also a good idea to carefully observe your child’s behaviour and record any abnormalities so you can provide clear and comprehensive information needed by the professional later on.