Does my child have autism spectrum disorder?

Just a few decades ago, autism spectrum disorder was a something that people rarely ever heard of let alone understood. These days, it's much more ubiquitous, but still not quite understood.

By definition, autism is a mental condition, present from early childhood, characterized by difficulty in communicating and forming relationships with other people and in using language and abstract concepts. While there are still so many questions and controversies about what autism is, isn't and what causes it, the warning signs are fairly well known.

No one behavior, tick or quirk is enough to label a child autistic or put him or her “on the spectrum.” That is a decision that comes from a lot of observation and serious consultation with the child's physician and other experts to make that determination. That said it's a good idea to keep an eye out for warning signs early in a child's development.

"It's best to screen early and often," said JoAnn Cobb, a licensed social worker and Program Director of Early Childhood and Family Support with Child and Family Services in Manchester. "As a rule of thumb, the earlier you catch it, research is showing, the better outcomes you will have."

Autism typically is evident before the age of 3, which is why, she said, pediatricians will typically screen for autism at 18 and 24 months, using what is called the Modified Checklist for Autism in Toddlers (M-CHAT).

The M-CHAT, is a screening tool that used in conjunction with broad developmental screening at 9, 18 and 24 months, helps physicians determine if a child is at low or high risk for Autism. The test, a full version of which can be found, taken and scored at, is 20 questions asking parents and caregivers to assess how the child is relating to others and communicating. Sample questions include: if you point, does the child look at the object you are pointing at; does the child play make believe; does the child like climbing; is he interested in other children; and, does he smile when you smile at him.

Many of the signs and symptoms of autism involve impairment in the child's ability to communicate and relate to people. Deb Hansen, a pediatrician with Cheshire Medical Center/Dartmouth-Hitchcock, Keene, says signs of autism could show up as early as infancy. For instance, most babies will start to smile as early as six weeks. But if an infant is not smiling or making noises, such as cooing or babbling to show pleasure or interest, that might be something to note at the next pediatrician visit.

Cobb adds that babies who may be on the spectrum might also have trouble making eye contact or the eye contact they make is fleeting. Further, as they get older, they don't show much interest in other children. They don't really have friends and they don't seem to be having fun.

Communication is also a challenge for those on the spectrum, so caregivers and parents may want to keep a close eye on language skills. Early on babies tend to develop a sort of call-and-respond language with their caregiver where he or she will say something to the child and the child will respond with a sort of babbling that mimics adult speech patterns.

As they get older, an autistic child may not have many words by about 18 months. For some children on the spectrum, they may hear a parent or caregiver say a word and they repeat it over and over again, which is called echolalia, but never use it again.

When it comes to behavior, Cobb suggests watching out for repetitive behavior. In early childhood, parents and caregivers may want to watch out for children methodically lining up his or her toys for example and getting upset when one is out of place. Further, another warning sign may be when a child gets intensely focused on one thing (a song, movie, toy, etc.) and gets upset when that concentration gets broken.

"They tend to be inflexible about their routines and rituals," Cobb said. "It makes transitions really hard for them."

Both Cobb and Hansen said the best thing to do when a parent or caregiver notices some of these behaviors and has concerns is talk to a pediatrician.

"I always take a parent's concerns about this seriously," Hansen said. "They know the child much better than I do and are able to observe them much more than I can in a 15-minute office visit. Even if it turns out to be normal behavior, we’ll talk about it and do some investigation."

Part of that process is going through the M-CHAT and developmental goals. If the child appears to be at high-risk according to those guidelines, he or she is referred for an assessment. This can be done in a variety of settings, but it's usually a session with a panel of experts who get to watch the child play and interact over the course of several hours.

While a diagnosis of autism can be scary, if it's diagnosed early, there are ways to mitigate the effects of the disorder including exercises parents can do at home. There are also myriad support groups, networks and services to assist with education, speech and occupational therapies, available to children and families of children with autism.

Melanie Plenda is a full-time freelance journalist and mother living in Keene.

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