Not long ago, a family came to see me with concerns that their toddler
wasn’t communicating like other 18-month-olds. We don’t expect a lot of
speech at that age, but this little boy wasn’t waving bye-bye, or turning
when his parents called his name or bringing them his favorite toys to
share his enjoyment.
So, after speaking with their pediatrician, they called their county’s
early intervention program, whose providers began to work with him, and
they also called me to meet with him. As a developmental pediatrician for
many years, I evaluated him and concluded that he had an autism spectrum
disorder, or ASD. Armed with this diagnosis, his parents were able to
enroll him in speech and occupational therapy. As I continue to monitor
this little boy’s progress, I’m delighted to see a steady increase in his
level of engagement with his parents during our office visits.
During the 40 years I’ve been in practice, I’ve watched as cases of autism,
a neurodevelopmental disorder affecting communication and behavior, have
quickly risen. Once rare, ASDs are now believed to impact about 1 child in
68 – or 1.5 percent of the child population, with symptoms ranging from
mild to severe. Parents most often become concerned when they notice a
delay in their toddler’s language, though other times it’s a pediatrician
or other specialist who first detects something atypical in the child’s
development.
Until recently, many pediatricians encouraged concerned parents to watch
and wait, suggesting that the child might outgrow the behaviors and delays.
Today, we know it’s important to intervene early – 18 months is a frequent
target. This can make a big difference in helping kids with ASD to learn
new skills and more functional behaviors.
That said, it’s important to know that intervention at any age can be
extremely helpful, and it’s never too late to start. Even when parents
worry they have lost time by starting later, they have probably already
been doing more for their child than they might realize: Just singing
nursery rhymes or playing peek-a-boo offers support similar to what many
interventions provide.
With all the attention that autism has been receiving, you may worry when
you notice minor differences between your toddler and his or her peers.
Many of these differences are simply typical variations in human
development. But if you see several (not just one) of these red flags, it’s
probably worth talking with your pediatrician:
-
Inconsistent response to name
: Your child often appears to ignore your calls or not hear them. -
Not waving or pointing
: Toddlers between 12 and 14 months should point to something they
want and – more importantly – point to share enjoyment or
excitement by 14 to 16 months. -
Speech delays
: These can include little or no speech; echolalia (when I say “Hi,
Joe,” the young patient responds by echoing the phrase back to me);
pronoun reversal; or using what I call “packaged language” instead
of more spontaneous speech (I treated one boy who, at almost 3, did
not say “Mama” or “Dada,” but often used phrases like, “Ready, set,
go”). -
Repetitive movements
: Many children without ASD exhibit some of these in the toddler
years, but if you see flapping hands, body rocking, spinning or toe
walking along with language delay, it may be more
significant. -
Sensory issues
: Either seeking out sensory input like loud noises or firm
pressure, or avoiding it; or becoming upset by sounds, textures,
bright colors or strong smells. -
Rigidity
: It’s not unusual for a toddler to throw a tantrum if she gets the
blue cup when she wanted the red one, but for some children this
goes a step farther: certain things – whether it’s the route home
from the library or where the ball gets stored – must be a certain
way, or a severe meltdown results. If this happens with your child,
speak with your pediatrician. -
Motor delays
: Children should walk independently by 15 to 18 months. If your
child is not walking by 15 months, consult with your pediatrician. -
Lack of social smiles
: Babies under a year old should respond to a smile or smile back.
Beginning intervention as soon as possible will give you, as well as your
child, the tools you need to facilitate development in the areas of
concern. Every state offers free early intervention services (though they
may go by different names), and many states require insurance companies to
cover additional services like speech or occupational therapy.
If you are concerned that your toddler may have an ASD, here are some steps
you can take:
-
Speak with your pediatrician
If your pediatrician wants to “wait and see,” and you are
. Your pediatrician should refer you to early intervention services
and arrange for an audiology appointment – either through early
intervention services or a hearing specialist, to rule out hearing
issues. Your pediatrician should also refer you to a specialist –
like a developmental pediatrician, child neurologist or child
psychiatrist – to help determine whether your child has an ASD or
another disorder, and to help put a treatment plan in place.
uncomfortable with this approach, you can guide him or her. For
example, say, “Maybe I should speak to a specialist; whom would you
recommend?” Meanwhile, you can self-refer to early intervention
services. -
Expand on your child’s interests to encourage back-and-forth
play.
For example, if your child likes taking things in and out of
containers, get a toy shopping cart and pretend food, and act out a
trip to the market. If he requests that you blow more bubbles by
putting the bottle in your hand, seeming to ignore the person
attached to it, hold your hand near your face so he connects your
actions with you instead of your hand. -
Feed your child whole, nutritious foods to keep her body
healthy.
One rule of thumb is that anything you can store on a shelf should
not be eaten in large quantities. -
Downplay electronics.
A little screen time is OK, but kids with ASDs tend to have more
challenges with fixation, and should spend the bulk of their time
playing and engaging.
As a parent, if you have concerns, follow your gut and seek the support you
believe your child may need; there are no downsides to interventions, and
most would benefit typically developing children as well. The earlier we
can develop pathways to help build on play, communicative intent and
interaction with others, the better the outcome for any child with ASD.
For more information and resources on autism, visit the American Academy of
Pediatrics’ website or the Autism Spectrum Disorder site of the Centers for
Disease Control and Prevention.
