Background: Professor Tony Bailey
Here Professor Anthony Bailey, Chair of Autism, University of Oxford, answers questions about autism spectrum disorders. {media 35825,35826,35827,35828,35829,35830,35831,35832}
Early signs of autistic spectrum disorder in children: Developmental milestones
The characteristics of autism vary from person to person but are generally divided into three main groups:
- social communication difficulties
- social interactions
- difficulties with social imagination.
It is often difficult to identify autism in very young children but many parents we talked to described noticing unusual or concerning signs, such as a delay in talking, during their children’s early development. Other parents did not notice anything particularly unusual at the time but once their children were diagnosed with autistic spectrum disorder (ASD), they looked back and identified particular behaviours or characteristics that they thought were an indication of autism.
Jane thought her son was different from the day he was born.
The most common signs that parents noticed were delays in developmental milestones such as walking, talking, pointing or smiling. Parents’ responses to these delays were often shaped by whether the child was their first child or whether they could compare their child’s development to a brother or sister. Parents were less likely to notice unusual development patterns if they only had one child. Parents with more than one child compared their children’s development.
Alison and Tony noticed how their son’s development differed to that of his sister.
While some children reached developmental milestones at expected times many were late to talk, walk or become toilet trained. Some children missed a developmental stage such as crawling altogether. One mother said, “We didn’t do potty training. One minute he was in nappies and the next minute he was on the toilet – he didn’t conform to any of the books.”
Sandy thought her son had been practising in secret when he walked without crawling.
Regression around the age of 15–21 months is common in about a quarter of the children diagnosed with autism, and a few parents described how their children regressed and lost some of the skills they had developed.
Talking and interacting
Many parents said that their children had unusual speech patterns. Some children talked late, others didn’t talk at all or made noises that differed from typical baby ‘babble’. As one parent commented, “Right from the beginning I knew there was something different because he didn’t babble, he didn’t make the usual noises.” Many children had had speech therapy and began to talk when they were between 3 and 5 years old. Two children spoke early but then regressed when they were around 18 months to 2 years old and lost the language they had learned.
Helen and Jason’s son’s speech was delayed but he talked in sentences straight away.
A few children repeated words or phrases they heard, a form of speech called echolalia. Some parents we spoke to said their children copied voices from DVDs or the TV and spoke like ‘Darth Vader’ or Nigel Havers, using the same intonation, accent and rhythm.
Amanda’s son recites sections from his favourite Disney DVD perfectly.
In addition to speech, parents identified other signs to do with communicating with people. For example, some children did not point to things or respond to sounds like clapping, leading some to suspect a hearing problem. While such problems are rare in children on the autism spectrum, it is important to test hearing. A few children did not smile, while others did not want to be cuddled or make eye contact with people, which parents found unusual. Some parents described their children fighting against cuddles. A few parents described how their children had blank expressions and did not respond in a typical way, and some children were described as being in their own world (see Communication: understanding).
Caron began to worry when her son was about six months old and did not smile at people.
Dot’s son hated being cuddled and was tireless at night.
Several parents children had been unusually quiet and content as babies and spent hours lying in their cots or pushchairs. Although other people commented on what good babies they were, these parents were concerned that the children did not demand food, drink or attention. A few of these children did not cry until they were over a year old, but some children were the opposite. One mother described how her son “came out screaming and that was all he did: scream and scream and scream. He would feed for a couple of minutes, go to sleep and then wake up and scream for 2 or 3 hours.”
Christines son didn’t cry and had delayed speech but she thinks it’s easy to look back now and…
Several parents we spoke to remarked that their children did not play with other children or join in activities such as song time at playgroups or nursery. A typical comment was “all the kids would be playing and he would be at the other end of the garden.” Some of the children found playing with other children difficult because they wanted to play by specific rules and could not be flexible (see
Communication: understanding). Other parents described their children as loners; and many of these enjoyed being outside and loved nature and animals (see Activities).
Early signs of autistic spectrum disorder in children: Behaviours and action
While there is no evidence to suggest a link between autism and birth complications, a few of the parents we talked to described complications during...