Too young to diagnosis Autism?

Dear Melissa,

At 18 months, is it too early to diagnose Autism? 

Let me start by admitting that this blog is a bit more serious than the last few. Although this topic takes on a very serious tone, I must make a confession:  

I LOVE children with Autism. Period.  

It is my passion. It is what I do.  

Children with Autism see the world in a delightfully unusual way, and I love it. However, the world of Autism is largely unknown, and many people are scared. With the CDC reporting that 1:68 children in America now have a diagnosis of Autism Spectrum Disorder (ASD), most of us know at least one child (or adult) with this diagnosis. This also has many parents in a panic. 

How do you know if your child has Autism? This is the tricky part. Unlike diabetes or a broken arm, there is no simple blood test or x-ray to make a definitive diagnosis. Many clinicians speak of “Autism-like symptoms,” but what does this mean? And at what age do you know you have a problem? 

The CDC states that by 2 years of age, a diagnosis of Autism Spectrum Disorder given by a medical professional is “highly reliable.” They also report that an accurate diagnosis of ASD can be made at 18 months or even younger. In my personal practice, I have seen several cases of children who come to me for a 14-month evaluation for something other than Autism (e.g., food aversion, not walking), and it was obvious that these children had Autism. These children went on to receive an ASD diagnosis by a physician around 2 years of age.

What should parents look for? Possible “red flags” for Autism include:
>Not responding to their name by 12 months.
>Not pointing to objects of interest by 14 months.
>Not playing “pretend” games (e.g., tea party) by 18 months.
>Avoiding eye contact and preferring to be alone.
>Delayed speech/language skills.
>Repeating words/phrases over and over (echolalia).
>Demonstrating obsessive interests.
>Flapping their hands, rocking body, spinning in circles, or other unusual repetitive movements.
>Unusual reactions to the way things smell, look, taste, or feel.
>Any significant loss of skills that were once mastered.

Now, I am a firm believer that kiddos are just quirky. Aren't we all? If you have a child that displays a single one of these characteristics for a month or two and then basically grows out of it, there is no need to worry. A typically developing child may think a movement (such as spinning) is really neat for a month or two, and then move on to the next fascination (such as obsessing over trains). However, if a “red flag” behavior persists for more than a month or two, definitely consult your pediatrician. For me, the biggest concern is the loss of any skills that were once mastered by the child. This is most certainly a reason to have a discussion with your pediatrician, pronto!

A good question to ask is "does my child repeat a particular behavior because it is a great way for him to engage with me?"  For a parent of a young child with Autism, the answer to this question will likely be no. Children with Autism tend to not be highly relational with their preferred activities. In contrast, a typically developing child may choose to repeat activities over and over to gain his parent's focus and attention.   

Early intervention and treatment of Autism is vital to creating the most functional outcomes.  On an upcoming topic I will discuss the importance of receiving early interventions and the treatment options available to parents.  

Resources:

Screening and Diagnosis, CDC 

Signs and Symptoms, CDC 

Early Warning Signs, UC SanDiego 

Autism Symptoms, Mayo Clinic 

Diagnosing Autism, American Academy of Pediatrics