Autism in Kids Under Two Years Old

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Though autism can be reliably diagnosed in children as young as 1.5 years old, the average age of diagnosis is around 5 years old nationally.  Knowing what autism looks like in young children is the first step to making sure they get the testing and treatment they need in order to live their lives to the fullest.

The Importance of Early Autism Detection

Autism is a developmental disorder that can change the way that people behave, communicate, socially interact, and learn.

With autism, it is believed that the earlier the diagnosis, the better a child’s long-term outcome will be.  Early autism detection and treatment is important because a child’s brain is most adaptable when they are very young and that adaptability decreases as they age.  Most early intervention treatments take advantage of the brain’s ability to reorganize in these early years by teaching children skills and coping techniques that will aid them throughout their entire lives.

Autism can be reliably diagnosed at as early as 18 months of age.  Unfortunately, many children do not receive a diagnosis until much later.  Children who receive treatment later are less able to learn new skills and certain abilities may be impaired (such as the ability to use language).

To make sure that your child has the best start possible, it is important to know the signs of autism and track their developmental milestones.  Remember – there is not any one clinical test for autism (for instance, autism will not show up on a blood test).  Autism is diagnosed based on certain behaviors that your child may show, so knowing what those behaviors is important.

Autism Screening

Children should be screened for autism at their 18- and 24-month pediatrician appointments.  Similarly, pediatricians should do developmental milestone testing at each of your well-child check-ups.  (If your pediatrician does not do 18- and 24-month screens, you should ask that they be performed.)

Many pediatricians use the screening tool called the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F).  This is a 20-question screening, that can help determine if your child shows signs of autism.

It is helpful for parents to learn the signs, so they can bring up any concerns to their child’s healthcare team.  Below is a link to the M-CHAT questionnaire.

https://mchatscreen.com/

The Early Signs of Autism (Before 2 Years Old)

Often, the early signs of autism are more subtle than later symptoms, so families and healthcare professionals may have a difficult time detecting them.  Therefore, it is very beneficial for parents to understand these signs and talk about their concerns with their healthcare team.  In particular, in children under 2 years old, autism may manifest through:

1. Joint attention delays or absence: Joint attention is the ability to connect an object/event to another person by looking back and forth between the object and the person.  It is a skill that allows two people to focus on the same thing at the same time and acts as a building block for more complex communication and social skills.

  • Kids with autism have difficulty with this skill at each every age – they may lack joint attention or be delayed in developing joint attention.
  • To help understand what a lack of joint attention looks like in children under two years old, please see the table below:
  Scenario Kids without Autism Kids with Autism
12 months A parent points to an object. The child will immediately look where the parent is pointing to, look back at the parent, and copy the parent’s facial expression.

 

 The child will not look where the parent points to, appearing to ignore them. A parent may worry if their child heard them.
15 months A child wants an object they cannot reach. The child will point to the object they want. The child will use a parent’s hand to lead the parent to the object they want, and sometimes they may place their parents’ hand onto the object. They will have little to no eye contact during this.

 
18 months A child finds an object interesting. The child will look back and forth at the object they like and at their parent. This is so they and their parent can enjoy looking at the object together.

 

 The child will point to the object, so their parent brings it to them, not for the shared experience of enjoying the object together.

 

2. Language delays: Most autistic children will have delays in verbal and nonverbal communication.  Those delays can manifest as difficulty with labels, a tendency to repeat themselves, and/or by using language in unusual ways:

Labels:

  • Children may know the word for an object they want but struggle to use the label to ask for it.
  • Children might have labels for object before having labels for people or family.

Repetition:

  • Typically, kids experience a phase of repeating the things they hear.
  • This phase can last longer for children with autism, and in addition, they will repeat lines from other conversations/movies in the tone they heard them spoken in.

Unusual Language

  • Children with autism may meet language milestones as toddlers, but their language may be unique.  For example, they may sound more like an adult than toddler when speaking.

3. Difficulty with Social Skills: Autistic children may have difficulty with the non-verbal aspects of language.  They may:

  • Have difficulty maintaining eye contact. They may not wish to make eye contact or hold eye contact for an unusually long amount of time.
  • Have difficultly reading facial expressions – for example they may not recognize or response to sad faces.
  • Not engage in pretend play. Most typically developing children start playing make-believe between 24 and 36 months.  Autistic children may start playing pretend later or not at all.

4. Loss of language and social skills: About one fourth of autistic children lose language and social skills between the ages of 15-24 months. 

Developing Technologies for Autism Detection

One of the difficult aspects of diagnosing a child with autism, is the lack of objective, measurable data.  That is because autism is diagnosed based on behavior rather than on biochemical testing.  As a result, providers may take longer to conclude that autism testing is necessary.  In order to help diagnose kids earlier, new technologies are being researched and developed.  Some of those technologies include:

Eye tracking devices

  • Eye tracking is a noninvasive and convenient tool that can help diagnose kids as young as 12 months with autism in a matter of minutes, rather than hours/days.
  • Because autistic people have different attention patterns, their eye movements and gaze patterns also differ from typically developing individuals.
  • The screening tool (GeoPref test) uses an invisible infrared light to follow a baby’s eye movement while they watch several videos of moving shapes.
  • EarliPoint makes testing modules that can be presented to children using computers or tablets to detect autism with a very high degree of accuracy.

Movement Analysis

  • Autistic children tend to have difficulties with movement. They can be more clumsiness, have difficulty with motor coordination, have unstable posture, and have trouble with purposeful movements, like writing.
  • This test would provide additional data to help support standard diagnostic methods.

Speech Detectors

  • Research has found differences between the speech of autistic kids and typically developing kids.
  • Devices are being built to detect unique speech patterns and assist in an earlier diagnosis of autism.

For all technology, there is more research and development required before the implementation on a large scale; however, this shows a promising future in finding innovative ways to diagnose autistic kids earlier and improve their outcomes.

 

Article by: Sarika Mahajan and The Autism ToolKit

 

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