Early Warning Signs and Best Treatment Options for Kids with Autism
Early Warning Signs and Best Treatment Options for Kids with Autism
Over the past twenty years, I have had the opportunity to work with many amazing kids who were developing differently from their peers. Work with these kids also meant work with their parents. When a parent sees or notices differences in the way children develop skills and/or rate of development this can be a signal that an autism spectrum disorder is shaping how a child is growing and learning. But what can parents look for, how can they have their children assessed, and how can they help their children become the happiest, healthiest people possible?
Broadly speaking, autism impacts how a child’s language, social skills, and thinking develops. Children diagnosed with autism spectrum disorders often have strong, specific repetitive interests and sensory sensitivities. But here’s the thing: there is a wide range of ways that an autism spectrum disorder impacts children. It is really hard to define a specific and clear “picture” of autism because of the way the different indicators show up in different clusters, with different children at different developmental stages. As a result, it can take a highly trained professional eye to spot variations of autism in young children.
In some communities there is a sense that labeling autism as a disorder and focusing on “treating” it does a disservice to people with autism. Here are a couple of thoughts about that. First, indeed there are countless happy thriving successful people with autism living, loving, learning and leading in the world. There are often strengths that people with autism have- including an ability to retain enormous amounts of information about specific topics, and the ability to think outside the box to solve problems. The goal of identifying autism in young children is not simply to “normalize” them or “treat the uniqueness out of them.” The goal is to help them be individuals who can form relationships and friendships, recognize social cues, and pursue their passions.
Rates of depression, anxiety, and decreased executive functioning can be higher in older youth with autism. Research suggests that with an accurate diagnosis and early interventions that are thoughtfully done with children can lead to big changes in skill development and help the brain grow and develop in ways that ultimately help behaviors be less repetitive, a variety of forms of learning come more easily, and social awareness and connection come more easily.
The data we have is clear. Early intervention with autism (especially between the ages of 2-6) can be enormously helpful for children. Many children that get early intervention starting as early as eighteen months or sooner learn to develop necessary social, emotional, and language skills such that by the time they are ready for preschool have very little to no developmental delays. However, the brain stops developing these skills somewhere between 4 and 6 years of age, so after this point intervention therapies are not as effective. This doesn’t mean that doors slam shut on a child’s growth, but brain growth and neural connections happen fastest and more comprehensively during this early window.
Recognizing Early Signs of Autism
Mild to moderate autism spectrum disorders can be much harder to recognize than more severe delays and/or behaviors. But there are signs to look for, even in infants as young as six months old, that can give parents a clue that their child’s social and emotional development may be off track. Very early, as early as 3-6 months, infants focus on facial features, the eyes, nose, and mouth. As early as 9 months they start to track where parents are focused, and at twelve months their language skills start to take off. If you notice a child who doesn’t focus on your face, doesn’t cue into where your attention is focused, and doesn’t start to mimic sounds and form words by around twelve months of age, these can be signs of underdeveloped social, emotional, and language learning.
If parents see a delay as well repetitive or obsessive behaviors or under or over-sensitivity to stimuli this should be a sign your child needs to be assessed for autism. If your child doesn’t focus on faces, doesn’t show joint attention, focusing on where another person is looking or sharing cues, or doesn’t seem to pick up on physical cues, smiles, nodding, can be signs of tracking the autism spectrum. Further if the child seems like they’re in their own bubble you should seek out a specialist.
Sensory symptoms may be increased sensitivity to feel or touch. Tags or seams seem to bother the child. A child may have increased sensitivity to noises like vacuums or a toilet flushing. Alternatively, they may have reduced sensitivity to pain. Children may exhibit inflexibility with switching routines and seem to need a rigid schedule. They make repetitive motions and or display behaviors of self-harm in more severe cases.
The best place to start asking questions about your child’s development is a pediatrician. Ask the pediatrician for an assessment. They should refer you to a specialist. I will also add that there is something to be said for your “parent gut.” Trust it. If something doesn’t feel right or if your pediatrician hesitates, I always say it is better to have the concerns ruled out. Pediatricians usually see kids in their offices solo or with known and trusted parents. Sometimes it really helps to have a full specialized assessment that allows the assessor to speak with school personnel or observe children in social situations. If your pediatrician does refer you, try to make sure that the specialist has experience and training in detecting signs of autism. Mild autism can be hard to detect. If you see at least two of the signs and/or behaviors in your child, we suggest that parents make sure they are assessed.
Early Intervention for Autism
As noted above some have been critical of interventions for autism saying that it is ridding the person of their natural abilities. This is just not true. There are also criticisms of dry, harmful, mechanized interventions. I certainly don’t support those. The intensive early interventions also need to be done by trained professionals who understand and celebrate children, and especially children with autism. You will want to find a team that engages your child, keeps track of growth, and includes you in the process. Early intervention aims to increase strengths that are underdeveloped. Whe brains are young and still forming, reinforcing neural connections helps those areas of the brain become stronger and therefore the outlook for increasing skills in those areas where a child may have deficiencies increases.
Treatments are so effective that even insurance companies recognize their value. Research shows that 47% of children who receive early intervention, ABA methods at least 20-40 hours a week, make massive strides, overcoming their diagnosis and transitioning to mainstream classrooms by preschool to kindergarten age. But it is critical to reach these kids preferably by age 2 but definitely before age 4-6 when the brain slows maturation in these areas. In addition 33-47% show increased social emotional skills with early ABA intervention.
ABA, applied behavior analysis, programs aim to shape learning and increase learning ability by introducing and re-focusing children on tasks or skills that are hard for them to process. A good program presents these in ways that are fun for the child. Through play children learn to play in parallel, then interactive play. They learn to focus on a face rather than a toy or far off object. When they’re having fun they want to repeat these skills and their neural signals are emphasized and strengthened.
ABA programs like Pivotal ResponseTraining, The Early Start Denver Model, and the UCLA Lobos Model are all good intervention methods. Parents should look first for evaluators who are experienced and licensed. A professional with BCBA is licensed in autism spectrum disorders. You may want to check their experience with early intervention as well. Mild autism can be hard to detect. Each state has autism societies so check your local agencies. A good place to learn more about treatment efficacy is at ASATonline.org, the Association for Science in Autism Treatment website, which lists efficacy of various treatment options based on research.
If there is one take-home from the information presented in this post, it is to pay attention to your child’s development and to seek assessment and intervention early. Early intervention for autism increases a child’s odds of developing not only language and social emotional skills needed for leading happier and healthier lives. With treatment, autism spectrum children will be able to develop, learn, make friendships, and regulate emotions on track with their peers because the intervention corrects the under-developed portions of their brains. AND they can still be their amazing selves in so many ways.
Especially with increasing data around the effects of loneliness, early detection and intervention is crucial for kids. Early interventions (including ABA) help to correct uneven development of the brain, helping them form emotional, social, and language relationships while keeping their innate strengths.
