“Why can’t my child talk? What are signs of Autism? Does my child have Autism? I am kind of Google obsessed… but maybe it’s something else.”
I get comments like this weekly, and understandably. Autism can seem like an entire world yet to be fully discovered. We hear the word “Autism” and may immediately form an opinion or have an idea of what that means. Autism encompasses a wide and varying population of people, so it makes sense that the truth about defining characteristics and diagnosis get lost in the mix. It is called a spectrum for a reason. But, no one really explains this spectrum. So it leaves us parents to think, “what does that mean? Is my kid on this spectrum?”
“Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication (Autism Speaks, 2019).”
Although there has been great progress in the last few decades of understanding Autism, no cause or cure has been found. Even most doctors don’t know much about ASD. Although we love our doctors, they don’t all have specializations in this topic, which is why they will most likely refer your child to a speech language pathologist (SLP), occupational therapist (OT), or Board Certified Behavior Analysis (BCBA). These professionals will work with your child and determine if they suspect “red flags” for ASD. If so, they may refer you to a pediatric neurologist, who can assist in a formal diagnosis. Regardless of a diagnosis, these professionals can help provide services for your child to functional optimally in their natural environment, whether that includes improving speech, activities of daily living, appropriate behaviors or other areas of difficulty.
Back to your questions…
“What are red flags? What factors can influence development? What is the spectrum?”
When professionals say red flags, they are merely describing indicators of Autism or characteristic that have been found common across children with Autism. Many of these indicators become apparent as early as 18 months, though a more complete picture of children’s early developmental characteristics isn’t seen until about 2-3 years old. From the parents I have worked with in my career, most have an intuition that something different is going on with their child, whether it is Autism or something else. However, it can hard to differentiate a kid who is just being a child from an underlying condition. Red flags of ASD may include, but are not limited to:
- Very few or no words (relies on pointing grabbing, grunting, or babbling) by age 2
- Loss of previously acquired speech
- Limited eye contact
- Delayed overall language development
- Repetitive behaviors (flapping arms, rocking body, spinning, etc)
- Repetition of words or phrases (echolalia)
- Little or no response to name
- Increased negative behaviors compared to peers (screaming, crying, hitting, violence)
- Sensory sensitivities to sounds, smells, tastes, textures, light, colors, etc.
- Lining up toys or objects
- Picky eating
- Delayed social skills
- Co-occurring medical issues (i.e. GI issues, sleep disorders, seizures, anxiety, attention deficits)
When you look at this list, consider if your child has one or more of these indicators. A child with ASD might not have all of these red flags, but it is common for a child with Autism to have at least a few.
This is where the word ‘spectrum’ comes into play. Basically, the ways in which people with ASD learn, think, and problem solve vary greatly from “high functioning” to “low functioning”, from little deviation from typically developing children to great deviation from typically developing children.
Imagine two children are diagnosed with Autism. Both children have difficulty paying attention, have delayed language, and enjoy lining up their toys. One of the children requires just a few verbal cues or a visual schedule to be redirected to a task or calm their body, while the other child may need much more support; this child may need hand over hand assistance or could benefit from higher sensory input. Both children display the same red flags, but each requires different assistance to function at their best.
Most SLPs and OTs do not diagnose Autism (although SLPs can diagnosis ASD). But, we have quite extensive experience working with these children, have a very developed idea what Autism looks like, and we most definitely have the eye to spot these red flags among the varying personalities of children. Also, just so you know, any of these red flags of Autism do not necessarily mean Autism. Some characteristics go away naturally as kids get older, not because their Autism “went away”. Instead, they were probably misdiagnosed, probably at an early age, due to similar characteristics that were typical for that child.
Diagnosis can be hard. Professionals are not perfect, just like everyone else. We try our best and want your kids to move through life as best as they can. But, just so you know, you are not alone. You have support. We are here to listen, give advice and our professional opinion, and provide you as many resources as you need. If your gut is telling you that something is off, just come in and say “hi”, and we’ll use our keen eyes to scope out what’s going on. You are not alone in this secret world called Autism.
Written by: Liana Martinez, M.A., CCC-SLP