Dear Doctor Column, January 28, 2008

Early Warning Signs of Autism

Question:

My 2-year old son's speech development seems slower than other children his age. At age 1, he was making lots of babbling sounds and using several simple words, but since then, he has not made any real strides in language skills. And he doesn't seem to smile and laugh as much as other children his age. My pediatrician says all children progress differently, and we should wait and see, but I'm worried my child may have autism. Should I seek a second opinion or take the wait-and-see approach recommended by my doctor?

Answer:

Autism is one of a number of related conditions called pervasive developmental disorders or autism spectrum disorders (ASDs). These include autism, Asperger Syndrome, and Rett Syndrome. Children and adults with ASDs display a wide range of symptoms that can vary from mild to severe, but almost all have some degree of difficulty with communication, social, or emotional skills.

The number of children diagnosed with autism has risen sharply in recent years, although experts are not sure if the surge is due to a real increase in the number of children born with autism or better awareness of the condition by parents and pediatricians.

The behavior you have noticed in your son — not building his language skills as quickly as other children his age and a lack of facial expressions — can indicate he is not meeting normal developmental milestones. Taking a first step, learning to play, speaking, crawling, and walking are all developmental milestones children usually reach within a certain age range; delays in these areas could be a sign of autism or other developmental disorder.

The Centers for Disease Control and Prevention (CDC) in partnership with the American Academy of Pediatrics and a number of other organizations, has launched an awareness campaign to educate parents about early warning signs of ASDs.

CDC notes a child or adult with an ASD might:

• not play "pretend" games (pretend to "feed" a doll)
  
• not point at objects to show interest (point at an airplane flying over)
  
• not look at objects when another person points at them
  
• have trouble relating to others or not have an interest in other people at all
  
• avoid eye contact and want to be alone
  
• have trouble understanding other people's feelings or talking about their own feelings
  
• prefer not to be held or cuddled or might cuddle only when they want to
  
• appear to be unaware when other people talk to them but respond to other sounds
  
• be very interested in people, but not know how to talk, play, or relate to them
  
• repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language (echolalia)
  
• have trouble expressing their needs using typical words or motions
  
• repeat actions over and over again
  
• have trouble adapting when a routine changes
  
• have unusual reactions to the way things smell, taste, look, feel, or sound
  
• lose skills they once had (for instance, stop saying words they were once using)
  

The "Learn the Signs. Act Early." campaign includes an interactive chart explaining important developmental milestones children should reach between the ages of 3 months and 5 years.

You have already noticed signs of developmental delay in your son, and in such cases, CDC recommends developmental screening to assess whether your child is learning basic communication, social, and emotional skills at a normal rate.

Autism is a complex disorder and diagnosing children younger than 3 years can be difficult, but the earlier the disorder is recognized, the sooner children can get the help they need. Children who get early treatment for autism and other ASDs are usually better prepared to begin learning when they enter school, CDC reports.

Talk to your doctor about developmental screening and the possibility of referral to a child psychiatrist, developmental pediatrician, or other specialist. You can also contact your local early intervention agency (for children younger than 3 years) or public school (for children 3 years and older). To find information about resources in your area, log onto the National Dissemination Center for Children with Disabilities Web site or call 1-800-695-0285. CDC also has links to information for families.

Additional internet sources for ASD information and support include the American Academy of Pediatrics; the Autism Society of America, a nonprofit autism organization providing free information and referral services for parents; Cure Autism Now, an organization of parents, clinicians, and scientists dedicated to developing effective treatments and a cure for autism; and First Signs, a national nonprofit organization that educates parents and professionals about early identification and intervention for children at risk for developmental delay and related disorders.