Red Flags for Identification of Autism Spectrum Disorders

Indian Association of Health, Research and Welfare (IAHRW)

By: Dr Tanuja Monesh Prem

Autism is a Neuro-Developmental Disability known by the term ‘Autism Spectrum Disorders’.

The Fifth Edition of the Diagnostic and Statistical Manualof Mental Disorders describes Autism Spectrum Disorders as a Neuro-Developmental Disorder that is characterised by impairment in reciprocal social communication, social interaction and restricted / repetitive stereotypical patterns of behaviour, interests or activities. It is said to be more prevalent in boys than girls.

The entire journey from identifying a disability to assessment to intervention is one that Parents need to make and take with a team of reliable and qualifiedProfessionalsthat includeDevelopmental Pediatricians, Psychotherapists, Psychologists, Speech Language Pathologists, Occupational Therapists and Special Educators.

Autism Spectrum Disorders, as they are called, are a difficult set of disabilities to diagnose, since they present differently with each and everyindividual. Thepeculiar presentation of its characteristics,sometimes leads to a delayed diagnosis or an incorrect diagnosis. Girls with Autism tend to sometimes present different characteristics than boys with the same disability.

Before one gets to the stage of diagnosis and prognosis,Parents need to be aware of what markers to look for in their child’s developmental curve. Autism Spectrum Disorders can be identified in children as early as Nine Months of age. Yet most of them go undiagnosed till around Four Years of age. The typical deficits that Parents need to look for, can be categorized in different age-appropriatedevelopmental domainslike:

Language Development :

  • The child may display diminished babbling and/or there may be lack of response to stimulus i.e. interactivitycould be missing as early as NineMonths.
  • The child may demonstrate limited response or no response to his own name by TwelveMonths.
  • The child may not uttermonosyllables bySixteenMonths.
  • The first words the child uses, may sound odd (not meaningful or relevant).
  • By Twenty FourMonths, the child may not have yet developed Two-Word Phrases.
  • The child may repeat the last word heard or the entire phraseover-and-over again (echolalia) or display delayed echolalia by hummingadvertisements or dialogues.
  • The child may use a different tone of voice,which may range from aflat tone to a robotic tone to even a singsong tone.
  • The child may avoid eye contact or look at people/things in unusual wayseg: from the corner of his eyes or tilt his head to look at that person.
  • The child may not engage with another person using joint attention.
  • The child may respond with inappropriate expression to an event eg: Mother is crying and instead of comforting her, the child laughs or goes on with the activity on hand, oblivious of hisMother’s condition.
  • The child may have limited or no social smile.
  • The child may not use indicativegestures, such as pointing, summoning, asking and so on.
  • Thechild may have difficulty putting meaningful sentences together, thus making communication with others complex.
  • The child may not be able to engage in a conversation with another individual.
  • The child may make grammatical errors in their sentences.
  • The child may have trouble expressing comprehension of concepts such as prepositions, colours, sizes, categorisations, tenses etc…
  • The child may not follow verbal directions or instructions, thus demonstrating challenges with receptive language.
  • The child may show regression in acquired language patterns.

Socio Emotional Development :

  • The child may demonstrate incessant and unexplained crying bouts.
  • The child may display lack of stranger-anxiety as early as NineMonths of age.
  • The child may have limited or no shared enjoyment, including the act of showing something to another person or engaging in interactive activities such as waving bye, reaching out for something,by TwelveMonths.
  • The child may prefer to play alone.The child may not be able to initiate or join in play with other children.
  • The child may resist or avoid physical contact.
  • The child may interact unidirectionally, i.e. only to get something he wants. This communication could be gestural / non-verbal.
  • The child may not be able to share toys, books, food etc… with other children.
  • The child may be extremely rigid about routines, and may display a sense of upset when routines or schedules are altered.
  • The child may strongly anchor himself to oneParent and refuse to let that Parent out of sight.
  • The child may display traits of being passive or fearful, and not want to attempt activities thatother children his age engage in.

Activities of Daily Living, Gross/Fine Motor Development andSensory Challenges:

  • Between the age of NineMonths and FourYears, the child’s skills may appear to become regressive.
  • The child may display repetitive movements of hand or finger posturing, flapping, spinning, rocking and such similar actions.
  • The child may have delayed developmental milestones.
  • The child may appear to walk differently i.e. the child may walk on his toes.
  • The child may display excessive clumsiness. Tripping over hisown feet or not being able to coordinate his physical self in the area around him.
  • The child may seek out or avoid certain material or ambient textures, sounds or movements.
  • The child may display fixations eg: fixating on objects or certain kinds of stimuli, such as the light coming through the curtains, looking at things in odd ways or tracking such things as fan blades, wheels of cars, swaying of curtains, watching certain programs or actions on television or a gadget in a loop etc…
  • The child may have unusual response to smells or sounds. The child may cover his ears with both hands when exposed to certain sounds like a particular song or loud noise.
  • The child may have hypotonia of muscles making the limbs appear weak.
  • The child may not be able to hold a crayon, pencil, fork and spoon or scissors.
  • The child may not be able to form letters or copy shapes.
  • The child may not be able to dress or undress himself eg: wear / remove pants, button / unbutton shirts etc…
  • The child may have difficulty with swallowing, leading to coughing or choking or throwing up behaviour during a meal or after finishing one.
  • The child may take a long time to eat a meal.
  • The child may seem to be stuffing his mouth with food and swallowing without chewing.
  • The child may keep food inside the mouthforlong, whereby the cheeks puff up due to the collection of food.
  • The child may have difficulty in blowing on a straw or sipping from a straw.
  • The child may have extreme preferences for certain kinds of food. The child may have unusual reactions to food tastes or textures. The Child may not eat soft mushy food eg: khichdi, curds etc… or not eat food that makes a crackling sound eg: chips or wafers.
  • The child may have difficulty accepting new textures of food and display avoidance behaviours to specific foods and texturesbygagging, vomiting, blocking the spoon with hands or pursing lips, crying, pushing food away,  spittingout the morsel of foodetc…
  • The child may be prone to falling sick more often.
  • The child may have irregularbowel movements likediarrhea, constipation, loose stoolsetc…

Cognitive Development :

  • The child may have challenges with imitation.
  • The child may be hyperactive and unable to sit in one place, which in turn impacts focus and concentration skills.
  • The child may have difficulty with organising or may be over-organising toysand other material. He may engage in repetitive behaviour such as lining things up in formations or spinning things.
  • The child may not display generalisation skills required for pretend play.
  • The child may not show interest in functional play.
  • The child may play differently with a car,such as spinning the wheels ofthe car rather than pulling and letting go of a pull-and-releasespring action car.
  • The child may play with toys in the same repetitive styleeverytime, without use of imagination orchanging the pattern,and may display loss of regulation,if others make an attempt to join in.
  • The child may have obsessiveinterests or singleminded focus in conversations.
  • The child may be more interested in parts of objectseg: door of a vehicle or only the churner of the cement mixer toy, or on the other hand, the whole objectlike blankies, scrunchies, a particular car etc…
  • The child may have difficulty with executive functioning, emotional regulation, decision making and generalisations.

The above are signs or Red Flags for Autism that Parents need to be on the look-out for, from ages ranging from Nine Months to Four Years to even ahead. If the Parents observe two or more deficits in their child’s developmental curve then it is time to seek assistance from the team of Professionals mentioned hereinabove.

Since brain plasticity at a young age is such that, learning becomes comprehensive and healthy patterns develop for life; therefore, an early diagnosis of Autism Spectrum Disorders helps the Parents capture and benefit from the golden window of opportunity for their child. This window of opportunity is the crucial time for skill development, behaviour patterns to be taught, speech and communication development, cause and effect and much more; so that the child reaches his fullest potential in optimum time. Hence “The Early Bird Catches The Worm” is a popular adage that applies here too.

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Dr Tanuja Monesh Prem
Founder Director :Education Matters

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