Early signs of autism

Gestures, gaze, language... The first signs of autism are usually detected around 12 to 18 months of age. These signs appear gradually and subtly during early childhood and are often not given the importance they deserve. Therefore, the diagnosis often comes later, around 3 or 4 years of age.

But detecting these early signs of autism as soon as possible and being able to intervene early is fundamental to supporting the development and improving the quality of life of children with this developmental disorder. To this end, it is important that families, primary care professionals, and the educational community know what the most frequent indicators of autism are at each stage of early development (from 0 to 6 years).

WARNING SIGNS ACCORDING TO AGE

Children with ASD exhibit a qualitative impairment in the acquisition of certain specific skills. Therefore, it is essential to assess their socio-communicative development.

6 MONTHS

• They use less eye contact.
• They pay more attention to objects than to people (visual and auditory).
• Absence of social smiling in exchanges with the caregiver.

9 MONTHS (IN ADDITION TO ANY OF THE ABOVE)

• They do not follow a familiar object with their eyes when the caregiver points to it.
• There are no relational exchanges with the caregiver (sounds, gestures, "peek-a-boo game").
• They do not extend their arms prematurely when someone picks them up.

12 MONTHS ( IN ADDITION TO ANY OF THE ABOVE)

• They don't babble.
• They do not imitate gestures (such as waving goodbye, clapping).
• They do not point to get an object out of their reach, they do not show objects to get the attention of the caregiver, nor do they make eye contact.
• They exhibit strange movement patterns (stereotypies), and engage in solitary activities (hand or finger games in front of the eyes, rocking).
• Sometimes they seem not to feel, or they are hypersensitive to certain sounds.
• They present motor characteristics (hypotonia/hypertonia, hypoactivity/excitation).

15 MONTHS (IN ADDITION TO THE PREVIOUS ONES)

• They do not make eye contact when they talk to someone or when someone talks to them.
• They do not show shared attention (sharing interest in an object, activity, or other people).
• They do not respond consistently to their name.
• They do not respond to simple commands.
• They don't say "dad" and "mom" meaningfully.
• They do not say other words with propositional value (16 months).
• They exhibit particularities in the development of the reaction to unknown people (delayed or atypical: absent or poor reactions in situations of separation or reunion).

18 MONTHS (IN ADDITION TO THE PREVIOUS ONES)

• They do not say a single word with a propositional value (16 months).
• They don't know how to play symbolic games with toys (feeding dolls, talking on the phone).
• Lack of imaginative play.
• They do not respond when an object is pointed out to them (by looking, verbalizing, sharing the pleasure).
• They do not point to objects, verbalize, or establish eye contact alternately between the object and the caregiver with the sole intention of directing the adult's attention to the object (protodeclarative action).
• They do not bring objects to adults to show them.

24 MONTHS (IN ADDITION TO THE ABOVE)

• They don't make two-element sentences.
• They show no interest in other children.
• They exhibit a peculiar gait and/or motor skills (walking on tiptoes, turning).
• They exhibit self-harming behaviors (biting themselves, hitting themselves).
• They throw tantrums very frequently and resist environmental changes.
• They are very hyperactive, rebellious, irritable, and difficult to console.
• They prefer to play alone in a self-sufficient manner and are very independent.

FROM 36 MONTHS ONWARDS

Since detection is later, it is advisable to be alert to the presence of alterations in the following areas:

Communication and language:

• Comprehension and communicative aspects affected to varying degrees.
• Poor nonverbal communication.
• Poor or non-existent response to your name.
• Slang with no communicative value. Immediate or delayed echolalia (repetitions).
• Impoverished, ungrammatical, and sparse language. Pronominal inversion (refers to himself as "you, he, or she," speaks in the third person).
• Fluent language: literal, repetitive, dwelling on certain topics. Prosodic alteration (inappropriate melody, monotonous intonation).
• Regression or loss.

Social relationships:

• Limited edition.
• Lack of reciprocity.
• They're in their own world, they don't listen, they do their own thing.
• Lack of recognition or response of happiness or sadness from other people.
• Tendency towards loneliness, lack of social skills, lack of interest in other children and in participating in games.

Game:

• Absence or lack of imaginative play (they may make small deferred imitations).
• The symbolic content of the game is replaced by their personal characteristics, referring to a concrete register without representative content (they line up or classify the toys in some way, but do not use them for representation).
• Games or activities that attract attention because they are very repetitive, persistent, stereotypical, even obsessive.
• Unusual fixation on certain objects/toys, which they spin.

Repetitive and restricted patterns of behavior and interests:

• Fascination with some of the physical characteristics of objects.
• Resistance to changes in routines.
• Stereotypies (manual movements, rocking, spinning around, walking around the same space repeatedly, opening and closing doors).
• Sensory alterations (low tolerance to certain sounds, smells, tastes that affect life habits such as eating, clothing).
• Ritualistic behavior that closely resembles the behavior of obsessive-compulsive disorder.

WARNING SIGNS FROM 4-5 YEARS OLD:

Communication and language:

• Language impairment. Inappropriate melody, monotonous intonation.
• Unusual vocabulary for the chronological age or restricted to a topic of interest.
• Little spontaneous language or little reciprocity in conversation.
• Echolalia (delayed repetition of phrases or words).
• Limited interpretation of nonverbal language.

Social relationships:

• Difficulty or little interest in playing with other children.
• Inappropriate approaches to playing together (may manifest as aggression, obsessive interest in a game, disruptive behaviors).
• Anxiety or discomfort in situations involving changes in routines.
• Difficulties in interpreting the implicit rules of the game.
• Literal interpretation of double meanings or jokes.
• Limited eye contact.
• They show extreme reactions to the invasion of their personal or mental space (intense resistance when pressured with slogans different from their focus of interest).
• Difficulty understanding the different registers of emotional expression.

Behavior, interests, and activities:

• Disproportionate reactions to small changes (rigidity).
• Lack of flexibility and cooperative imaginative play, although they can only create certain imaginary scenarios (copied from videos or cartoons).
• A solitary, repetitive game with the same sequence.
• Sensory hypersensitivity (anxiety in response to noise, clothing, etc.).

With the aim of raising awareness of the main early signs of autism throughout society, and coinciding with the celebration of World Early Intervention Day, Autism Spain , in collaboration with the Aprenem Autisme association, has produced the video Do you know the early signs of autism?

If families identify these signs or have any concerns about their child's development, we recommend consulting their healthcare provider. Early detection is essential for timely intervention and improving the quality of life for individuals with autism.