What are the early signs that a child may have autism?

Some of the early signs that a child may have autism: difficulty connecting meaningfully with their caregiver (parent) and their environment. Children on the spectrum become easily entertained with inanimate objects and almost seem overwhelmed when they are confronted with face-to-face interactions.

As infants, babies who are later found to be on the spectrum often display emotions at unexpected times (crying when tickled or smiling/laughing when the typical baby’s reaction would be to cry—i.e. during shots or procedures). Babies at risk for autism don’t emote reciprocally (a baby at six weeks should start socially interacting, smiling reflexively when talked to/engaged with. If a baby seems like s/he is deaf or turns away from this type of interaction, it can raise a red flag). 

Babies who are under-sensitive or overly sensitive to sound should be monitored. Being overly sensitive to textures of foods or clothing may also be an early sign. Having an unusually large head can be an early finding.

Some babies are extremely difficult to console, while others seem to have a really “easy” time because they entertain themselves.  Most babies/toddlers on the spectrum have a very tough time dealing with changes in routine.  Some affected babies never attain expected normative milestones. Other babies regress developmentally: they stop babbling, stop crawling, stop making eye contact. 

Almost all of the aforementioned signs and symptoms ALSO occur in typically developing children at different times. Children on the spectrum tend to have more of the symptoms, and there are often glaring developmental differences between those affected and so-called “typically developing” children.  A child who is unusually bright or verbal at an early age should also be monitored for Autism Spectrum Disorders.

Lastly, in my experience, if one or more first or second-degree relatives (mom, dad, sibling, aunts/uncles or cousins) are “quirky” or socially awkward, there should be a heightened sense of awareness to monitor infants and toddlers for signs/symptoms of autism. 

There are a few screening tools we use in general practice that help us to identify toddlers who have or are at risk for autism (MCHAT) https://cms.m-chat.org/LineagenMChat/media/Lineagen-M-Chat-Media/mchatDOTorg.pdf.

 In recent years as our knowledge and understanding has increased, the medical community has broadened what falls under the autism spectrum.  What was previously categorized as a learning issue but now falls under the autism spectrum?

Autism primarily affects communication, language and socialization, and can sometimes be difficult to diagnose and differentiate from learning disabilities.  Children with autism are usually very intelligent, but they have trouble learning in a “so called” traditional manner. Learning difficulties and disabilities are often diagnosed in children on the Autism Spectrum.

Many affected children are “locked in” and difficult to test or diagnose. Many children have overlapping features with Anxiety and Attention Deficit Disorder. It is not uncommon for children affected by autism to be labeled as having IQ’s in the mental retardation range, when in reality we don’t have appropriate tools with which to accurately measure what these children know.

I prefer to not “label” children with diagnoses and disabilities, but instead I encourage parents to celebrate their neurodiverse differences and to look for their strengths, celebrating what they CAN do, and not getting too hung up on what they CAN’T accomplish. 

In your experience as a pediatrician, do digital devices such as tablets help children with autism or contribute to their autism?

It is interesting to note that the rising rates of autism, anxiety and attention deficit disorder almost directly parallel the rising rates of screens in the home, vehicles, daycare environment, schools and general environment.

I do not think that electronics or screens “cause” autism, but it is my personal belief and observation that the child who is genetically at risk for autism is potentially “primed” to display developmental differences when they are exposed to electronics in utero, in infancy, as toddlers and in early childhood. 

Children need to learn from and imprint on HUMANS, preferably their parent(s), and for reasons that are not completely understood, those children on the spectrum are unusually drawn and attracted to screens of all sorts (whether it be televisions, tablets or video games).  

Digital devices can be invaluable as tools to HELP children with autism when used in a therapeutic manner, particularly for children who have difficulty expressing themselves verbally.  Too often, however, I see parents who are exhausted from the daily challenges of raising a child who is different/difficult to nurture. It is important to provide appropriate support to parents and caregivers so that they can provide alternatives when their child’s only comfort IS their digital device.  

How can colleges prepare for the increasing number of autistic students based on the autism spectrum?

Colleges with strong Disability Resource Centers and Learning Support Programs can be invaluable for young adults (and their families) on the Autism Spectrum.  The colleges that are most successful often have students who are Special Education majors.  These young adults who are preparing to devote their studies to educating those that learn and think differently make compassionate roommates and friends, and make it easier for teens with ASD to adjust to college life.

Colleges can best prepare for increasing numbers of autistic students by partnering with the families of young adults on the spectrum, with a mutual goal of fostering independence while simultaneously minimizing anxiety for the student AND family.  In my experience, families who prepare well ahead of their child’s 18th birthday by establishing appropriate levels of legal guardianship are able to best ensure a smooth transition to college life. 

What are some of the national programs and organizations that are available to assist students with autism and parents who have children with autism?

There are many national programs and organizations. My favorites are listed below: 

This piece, written by my good friend Michelle Smigel, mother of a young adult with autism, can be found on a great resource, Next for Autism (https://www.nextforautism.org/news/twenty-minutes).

The blog knowdifferent.net is run by another good friend, Carissa Garabedian, and has some very good links to different support resources and wonderful monthly articles (http://knowdifferent.net/2017/12/07/vcu-center-transition-innovations-new-online-course-get-ready-college-resource-teens-disabilities/).

Autism Speaks is a national organization that has many resources (https://www.autismspeaks.org/) •