Earlier Intervention: Heeding the First Signs of Autism

By Gail J. Richard, PhD, CCC-SLP

Children with autism spectrum disorder (ASD) have difficulties with communication and social interaction. They also have restricted and repetitive patterns of behavior, interests, or activities. While there are not any definitive medical tests to diagnose ASD, there are specific developmental markers that strongly suggest the possibility of ASD as young as 12–15 months of age.

A formal diagnosis of ASD can often be made reliably by 24 months—and progress is being made to do so at even younger ages. Yet the average age of diagnosis is 5 years or even later. This gap is troubling because the greatest impact of intervention on reducing the challenges of ASD occurs before age 3. This means that many of the children with ASD miss the most critical time for treatment, when the brain is malleable and in its most rapid period of growth.

How can parents, caregivers, family members, and society at large improve this reality? Routine screening for ASD is essential and should be required at general wellness checkups at 18 and 24 months of age for all children. But the importance of parental instincts and awareness cannot be overstated.

Most referrals for ASD are initiated by parents rather than the pediatrician. Parents often notice developmental differences in their child and request an evaluation on their own. This is because many of the noticeable developmental differences revolve around communication interaction between the child and caregiver—both verbal and nonverbal interaction. Parents should be aware of communication milestones and raise concerns as early as possible if their child is not meeting them.

Communication milestones
Babies communicate through shared attention in activities, like pat-a-cake and peek-a-boo. Before children can speak, they learn to respond, take turns, and initiate social and communication interactions. While a child’s first word is greeted with much fanfare, much of what happens before that first word is spoken is communication.

Below are some of the early communication milestones that parents should expect their child to meet:

• Smiles at people (birth–3 months)
• Coos and babbles when playing alone or with parents (4–6 months)
• Giggles and laughs (4–6 months)
• Uses sounds and gestures to get and keep attention (7 months–1 year)
• Points to objects and shows them to others (7 months–1 year)
• Imitates different speech sounds (7 months–1 year)
• Uses a lot of new words (1–2 years)
• Asks who, what and where questions, like “What’s that?” “Who’s that?” and “Where’s kitty?” (1–2 years)

More milestone information is available at on.asha.org/child-hear-talk. Specific information about early red flags for autism is available at bit.ly/asd-red-flags.

Evaluation and treatment
Speech-language pathologists, also called SLPs, are often the first professionals to identify a child with ASD. Children can begin to receive communication services by a speech-language pathologist as soon as delays in meeting expected milestones are detected. A diagnosis of ASD is not necessary to start these services.

When evaluating young children, speech-language pathologists look for skills such as joint attention (sharing a common focus with another person about the same object or event), interactive play, and turn-taking. Gradually the nonverbal communicative interaction becomes verbal, when children start to imitate sounds and words, and initiate their own language production.

Social interaction is another key aspect of ASD that speech-language pathologists evaluate. A child who lacks interest in people and interaction, preferring to engage in repetitive motor movements or isolated play, is demonstrating high-risk behaviors for ASD.

Early intervention should begin as soon as possible to engage the child in promoting increased social awareness. A child needs to develop joint attention to benefit from exposure to language and stimulation provided by adults in their environment. Without paying attention to others, the child fails to process or learn from the world around them. Early intervention can affect brain development and is the key to minimizing the impact of ASD.

Benefits of early intervention
The Autism Society of America (ASA) estimates that the lifetime cost to society per child with autism is $3.2 million. ASA estimates that cost could be reduced by 67% with early intervention to address the symptoms of ASD.

Children who receive early intervention are more likely to be able to attend general education classes in school. They also may be less likely to experience behavioral problems that can result from frustration in not being able to adequately communicate. The earlier intervention starts, the better the prognosis for addressing any developmental lag.

It is important for parents to know that in the United States, early-intervention programs provide free assistance for children with developmental delays or disorders. A list of early intervention contacts by state is available at bit.ly/ei-contacts. Parents can also find a searchable database of speech-language pathologists at www.asha.org/profind.

Gail J. Richard, PhD, CCC-SLP, is the 2017 President of the American Speech-Language-Hearing Association. She is the director of the Autism Center at Eastern Illinois University.