By Mary Jane Weiss,  Ph.D., BCBA-D, Professor of Education and Director of Autism and Applied Behavior Analysis Program, Endicott College

Twenty-five years ago, it was not uncommon for individuals to be diagnosed with autism at age 5 or 6.  Back then, physicians might have reassured parents about the late age at which Einstein started speaking, or summarily dismissed the concerns of an anxious parent who felt that things “weren’t quite right.”  Precious time was often lost, when intervention in the toddler and preschool years might have made a large difference in the child’s development.

Today, autism is often identified with the earliest signs in toddlerhood, and even occasionally in infancy.  Over time, much has been learned about how autism first manifests.  Now, physicians are trained to ask questions (and sometimes administer assessment checklists) to parents at ages as young as 12 or 18 months.  Major warning alarms are sounded for the absence of key social behaviors such as reaching, pointing, and waving, all of which should be emerging by age 1.  These behaviors occur even before vocal language, and represent ways that young children interact with adults in their environment, express their needs, and request social connection. 

Even earlier, there may be signs that the child is not developing social reciprocity as he or she should.  Babies engage with adults at very young ages, beginning with social smiling.  If babies are not smiling by age 6 months or are not engaging in back and forth social exchanges by 9 months, there might be cause for concern.  Of course, not all babies who are slow to develop these skills or who are less effusive with their responses go on to develop autism.  However, it might be something a parent should share with the physician to see if more evaluation is warranted, or to ensure that more careful monitoring is put in place.  More must be done to help parents to understand the warning signs and to understand the earliest symptoms.  Behavior analysis can be on the forefront from both a detection and an intervention standpoint.

It might be especially important for babies who have older siblings with autism to be closely watched and potentially evaluated, since there is an increased genetic risk.  Parents and professionals can even review the list of questions associated with autism risk at M-CHAT (Modified Checklist for Autism in Toddlers).  These 20 questions focus on the unique patterns and indicators of risk for autism. Some of them are concerned with general social awareness (e.g., responding to name or appearing to be deaf).  Other items are much more focused on the development of social reciprocity, and ask about behaviors such as making eye contact, showing items of interest, noticing when the parent is attending to items of interest in the environment, and bidding for parental attention.  In addition, there are questions about unusual behaviors such as repetitive motor movements, restricted interests, or lack of social interest.

Early intervention is key to improving the outcomes associated with autism, and can make a life-changing difference. It is important for parents to become educated about early warning signs and to raise any and all concerns to the pediatrician.  Parents often sense something before any other person in the child’s life has become aware of the issue.  The myriad ways parents interact with and observe their child’s behavior put them in a crucial position to notice small ways in which development might be awry. Parents should be encouraged to ask about any unusual behaviors, and should also cite any concerns they may have about the failure for certain skills to be evident or to develop as expected. 

Professionals can help raise awareness about the early signs of autism and about the need for parental advocacy. As professionals in behavior analysis, it is important to work to identify individuals at risk for autism, and to ensure that they receive appropriate treatment.  It is also imperative to help parents, especially parents of younger siblings of children with autism, to identify the signs.  As society’s awareness increases, access to early intervention will increase.  For students interested in becoming an autism specialist, research and clinical opportunities abound in the early detection of autism and in the clinical treatment strategies that will help babies and toddlers who are showing signs of developing the disorder. Many developments in these areas are likely to occur in the next decade.

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