Day: February 7, 2022

When it comes to the early signs of autism spectrum disorder and potential interventions, early intervention for autism can cover a variety of areas. Here, you’ll discover strategies for parent advocates to add to their toolbox.

There are many different signs associated with autism, and research strongly shows the earlier a child receives intervention supports for autism, the more progress they make in all areas of their lives. Early intervention, a federally funded program, provides support for the youngest children, ages birth through three years old, who demonstrate developmental delays. This blog will talk about the early signs of ASD and interventions that support development in all areas. 

Early Intervention and Autism

Today, autism affects 1 in 44 children. According to the CDC, autism spectrum disorder is four times more likely to occur in boys. The best way to support children who are showing signs of a developmental delay is to get them therapy supports as early as possible. These supports are available from Early Intervention Programs, Health Insurance and private agencies. 

Every child is different and develops at different rates, so how are we supposed to determine if an Autism Evaluation is appropriate for a child under three years old?

The Early Intervention program is available to all children ages birth to three that live in the United States. The purpose of this program is to help identify and support children who have delays in all areas of development, with or without a diagnosis of autism.

One of the most commonly used questionnaires to determine if a child does have red flags for ASD is called “The Modified Checklist for Autism in Toddlers (MCHAT). This questionnaire can be filled out for free by a clinician or a parents. You can find the free online version here.

The five areas typically monitored when determining if a child should be referred for an autism evaluation are joint attention, social engagement, receptive language, expressive language and behaviors. If there are concerns in some or all of these five areas, completing the MCHAT assessment and talking to your child’s pediatrician is the first step to determining if more testing should be administered. 

1. Joint Attention

Joint attention is a skill that affects a child’s ability to interact with others.

The definition of Joint Attention is when two people purposefully pay attention to the same thing and for the same reason.

For example, when an adult calls a child’s name, and the child responds by looking at the adult, they are engaging in the first step of joint attention. The adult would then ask the child a question and when the child responds, the adult and child are talking to each other about the same thing, in that very same moment. The same goes for when an adult points to an object and the child follows that point to see what object the adult is showing them. Together they are able to talk about the same item.

According to the UNC School of medicine, “Children who are learning social and communication skills in a typical way will often show examples of joint attention from the time they are 12 months old. Joint attention is important in helping people communicate with each other all through life. Children with autism have a hard time with this kind of communication. For these children, delays in developing joint attention skills lead to delays in developing language.”

2. Social Engagement

As soon as a baby is born, they are in awe of their mothers voices and eyes. Infants thrive off social interaction, from playing peek-a-boo, being sung to and engaging in simple play activities.

As they grow, social skills become the foundation for other areas of development. They learn spoken words through imitation of adults and peers, babies and toddlers model behaviors of those they see around them, they get the attention of others to share their wants and needs, and they imitate other children’s play and movement.

One component of autism is a lack of social engagement, such as when a child doesn’t show interest in playing near or playing with other children or using words to communicate with primary caregivers.

3. Receptive Language

Understanding the meaning of words is the first step to language development. Without understanding the meaning of words, children won’t be able to use spoken words to communicate their wants and needs with adults.

Children start to show understanding of words as early as 4 months old, when they look towards objects and family members when they are named. As they get older, they start following points, imitating gestures and show interest in imitating sounds and words that adults use. 

Autistic children may have a harder time engaging in social reciprocity which impacts their receptive language development. This article from Raising Children describes how joint attention directly affects receptive language development in infants:

“Autistic children might have difficulty learning language because they tend to show less interest in other people in the first 12 months of life. They might be more focused on other things going on around them. Because they might not need or want to communicate with other people as much as typically developing children do, they don’t get as many chances to develop their language skills. For example, a three-month-old baby who is distracted by a ceiling fan is less likely to tune into a smiling and tickling game with their parents. By nine months, if the baby still isn’t tuning into parents, the baby is less likely to point at things they want to share with parents. The baby is less likely to listen to their parents as they name things. This means the baby misses these chances to build vocabulary.”

4. Expressive Language

Expressive language is the key to communicating our wants and needs with others. This can be through visuals, verbal words or using gestures.

When infants start to use gestures (such as pointing, waving “hi”, and lifting their arms to signal wanting to be picked up,) adults are able to understand what their child is wanting and respond to their requests.

From there, expressive language develops quickly into babble, jargon, word imitation and then children using one, two and three word phrases to communicate with those around them.

Children that develop early signs of autism don’t typically follow this language progression. Children might be more quiet then others, babbling less, use rote phrases (lines they hear in movies), use language that isn’t functional in nature, or label a variety of objects. This article does a wonderful job explaining the differences between a language delay and language concerns that point to Autism. 

5. Behaviors

Behaviors associated with children who may have Autism may also be an indicator of sensory differences. An autistic child may show repetitive movements (such as rocking consistently), showing aversions to being touched or sensitivity to sounds and lights in unpredictable environments (such as the grocery store.)

Children sometimes become upset for unknown reasons and are hard to calm down. Some autistic children become fixated on objects, only wanting to complete tasks in specific ways (such as lining up toys), always wanting to hold onto specific objects or getting upset when someone else changes the play sequence. Children who show signs of ASD also tend to need consistent daily routines and become upset when their routines change. 

The most common diagnostic tool for Autism in young children is called the ADOS (Autism Diagnostic Observation Tool), a play based assessment that is completed by a clinician with the child present. This assessment can be given to a child as early as toddlerhood. There are four different modules that can be administered to young children. Clinicians determine the correct module to use based on the skill level of the child. The ADOS assessment, along with the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) results will determine if a child meets the criteria that pertains to autism spectrum disorder. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is a completed diagnostic tool completed by the American Psychiatric Association that encompasses different psychiatric diagnostic criteria. The diagnostic criteria for Autism in the DSM-5 is described in this article. 

“A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history. 

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history.

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.”

Interventions for children with a diagnosis of ASD:

1. Early Intervention Services

The Early Intervention Program is a federally funded program that supports children in all areas of development, including language, cognition, motor skills, social skills and adaptive development.

The services available for children under the age of three are directly associated with every child’s individual needs. These could include feeding therapy, nutritional supports, speech and language therapy, occupational therapy, physical therapy, behavioral therapy, social language groups and more!

If a child is enrolled in the early intervention program, their parents or guardians play a key role in the implementation therapy services. Therapies usually occur at home, with parents involved. When a child turns three, their therapies are funded through the local school district Special Education Program to support school readiness, and medical insurance to support medical needs and behavior supports at home. 

2. Visual, Tactile, and Auditory Supports

Children with low social reciprocity and joint attention skills benefit from other forms of communication. These communication strategies utilize other senses and break down communication to simple and direct forms. If a child is having trouble calming down, creating a calm down corner using “Soothing Sammy Emotions Program” supports a positive calming experience with a golden retriever dog and sensory tools. 

Visual cue cards such as these First/Then choice boards and transition cards,  give children the ability to follow daily tasks and routines in a way that is easy for them to follow, without the need to look those who are talking to them.

Early intervention services can support with strategies:

• To increase on-task behavior or social interactions
• To teach new skills e.g., life skills, communication skills, or social skills
• To maintain self control and self monitoring procedures to maintain and generalize job-related social skills
• To generalize or to transfer skills from one situation or response to another (e.g., from completing assignments in the resource room to performing as well in the mainstream classroom)
• To restrict or narrow conditions under which interfering behaviors occur (e.g., modifying the learning environment)
• To reduce interfering behaviors e.g., self injury

As children become more comfortable with back and forth interactions with adults, first/then boards can be used as a back up option for communication. These visual schedules help children transition from one activity to the next. 

A final note on early intervention and autism

If you have  concerns about a child’s developmental progress, it is best to seek out professional assessments through a pediatrician or an Early Intervention team. If the child is over three, requesting a developmental evaluation through your local school district is also an option.

When children receive the intervention therapy they need at an early age, their skills in all areas of development improve. There are many different interventions we can do to support even our littlest family members.