From these studies, five distinct areas of development are flagged for consideration. All parents should consider these “Big Five” if they suspect that their child may have autism.
1) Does the baby respond to his or her name when called by the caregiver? Within the first few months of life, babies respond to their own name by orienting toward the person who called them. Typical babies are very responsive to the voices of familiar people, and often respond with smiles and looks.
In contrast, infants later diagnosed with autism often fail to respond to their own name. That is, when called by name, they tend to turn and look at the person only about 20% of the time as found- in the videotaped one year-old birthday parties of children with autism. They also are often selectively responsive to sounds. They may ignore some sounds and respond to others that are of the same loudness. Thus, they may fail to respond to their parent calling their name, but immediately respond to the television being turned on. It is not unusual for parents to suspect their child has a hearing loss.
2) Does the young child engage in “joint attention”? Near the end of the first year of life, most infants begin to join with their caregivers in looking at the same object or event. To aid in this process of “joint attention”, typical infants begin to shift their gaze from toys to people, follow other’s points, monitor the gaze of others, point to objects or events to share interest, and show toys to others. These behaviors have a distinct sharing quality to them. For example, the young infant may point to an airplane flying over head, and look to the parent, as if to say, “do you see that!”
In contrast, young children with autism have particular difficulties in jointly attending with others. They rarely follow another’s points, do not often shift their gaze back and forth from objects to people, and do not seem to share “being with” the caregiver as they watch and talk about objects, people, or events. They also tend not to “show” a toy to the parent.
3) Does the child imitate others? Typical infants are mimics. Very young infants can imitate facial movements (e.g., sticking out their tongue). As early as 8-10 months, mothers and infants say the same sounds one after another, or clap or make other movements. Indeed, imitation is a major part of such common infant games as pat-a-cake and So Big (“How big is baby? Soooo big!” as infant raises hands to sky).
Young children with autism, however, less often imitate others. They show less imitation of body and facial movements (waving, making faces, playing infant games), and less imitation with objects.
4) Does the child respond emotionally to others? Typical infants are socially responsive to others. They smile when others smile at them, and they initiate smiles and laughs when playing with toys and others. When typical infants observe another child crying, they may cry themselves, or looked concerned. Somewhat older infants may crawl near the person, pat, or in other ways offer comfort. These latter behaviors are suggestive of empathy and are commonly observed among children in the second year of life.
In contrast, children with autism may seem unaware of the emotions of others. They may not take notice of the social smiles of others, and thus may not look and smile in response to other’s smiles. They also may ignore the distress of others. Several researchers have now shown that when an adult feigns pain and distress after hitting herself with a toy, or banging her knee, young children with autism are less likely to look at the adult, or show facial concern.
5) Does the baby engage in pretend play? Someone once noted that “play is the work of children.” Young children love to pretend-to be a mother, father, or baby, to be a firefighter or police officer. Although children start to play with toys around six months or so, play does not take on a pretend quality until the end of the first year. Their first actions may involve pretending to feed themselves, their mother or a doll, brush the doll’s hair, or wipe the doll’s nose. Nearer their second birthday, children engage in truly imaginative play as dolls may take on human qualities of talking or engaging in household routines. Children may pretend that a sponge is a piece of food, a block is a hat, or a plastic bowl is a swimming pool that contains water.
In contrast, the play of children with autism may be lacking in several ways. The young child may not be interested in objects at all, paying more attention to the movement of his hands, or a piece of string. If interested in toys, only certain ones may catch his interest, and these may be used in a repetitive way that is not consistent with how most children would play with the toy. They may be more interested in turning a toy car upside down and spinning the wheels than pushing the car back and forth. Overall, pretend qualities are nearly absent in the play of children with autism under 2 years of age.
It is important to note that in each of the 5 areas we have flagged, we are most concerned with behaviors that are absent or occur at very low rates. The absence of certain behaviors may be more difficult to pinpoint than the presence of atypical behaviors. But concerns in any of the above areas should prompt a parent to investigate screening their child for autism. Several screening measures are now available, and information from the screener will help to determine if the parent should pursue further evaluations. If the parent is convinced their child has autism, then they should seek an evaluation with an expert in autism. Most likely, this evaluation will involve an interview with the parents to obtain a complete developmental history of the child, and direct observations of the child in different situations.
Luckily, Timmy and his parents were able to get the diagnosis of autism before Timmy’s third birthday. They began intensive treatment with Timmy, and he made immediate progress. They are hoping for the best outcome, and feel confident that his early diagnosis was critical in getting him the help he needs to reach his potential.