COMMENTARY

Detecting Autism in the Very Young: The Tell-Tale Signs of Babbling, Crying, and Trunk Control

Juhi Pandey, PhD

Disclosures

March 27, 2017

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Hi. I'm Juhi Pandey, a pediatric neuropsychologist at the Center for Autism Research at the Children's Hospital of Philadelphia.

Tracking the Subtle Behaviors of Autism Spectrum Disorder

I'm going to talk today about some early behaviors that families can track if they are worried about autism spectrum disorder (ASD) in their young child. These symptoms and behaviors can be tracked by all of your families as a complement to your medical care.

Pediatricians and nurse practitioners are on the front line with their patients. The parents who come to you have the most experience with you and you have the history that will help to define whether a specialist evaluation is needed. You are crucial to this whole endeavor. We know that we track physical, motor, and language development very well in young children. What might be missing in some cases is tracking social development, particularly the subtle signs.

Parents and practitioners are good at tracking the very obvious signs of ASDs. Those include such behaviors as flapping, spinning, and flagrant disinterest in social engagement. We know that those exist and that we're really good at picking those up. What tends to fall by the wayside are the more subtle behaviors. Our research from early detection and diagnosis of ASD has shown that tracking these behaviors leads not only to early detection, but also to early diagnosis and access to early intervention, which have very important downstream effects for global development as well as for ASDs.

Babbling and Crying: Clues to Social Engagement

When I talk about early behaviors with parents, what I'm talking about is the amount of social engagement that a child has with the parents and others—for example, babbling. How much babbling is occurring in the home? Is the child initiating that babbling, or is the parent initiating it? Does the babbling change depending on whether the child knows the caregiver or if the child is interested in engaging or finds something of interest? How about the child's crying? Does the child have different cries for different situations? Can you tell when the child is crying because of a wet diaper versus wanting an activity to start or stop?

Other examples include thinking about overall development; for example, how trunk control changes in response to hearing one's name is an important indicator for autism later on. If a child has very poor trunk control and isn't able to turn his head or body in response to sounds, or become interested in those sounds, we need to think about that early on. Another good example is reaching. We want children to be interested in their environment. Is the child reaching for something or beginning to point or grunt when he wants something? Then we can ask parents over time if the child does that only for specific things (which might indicate repetitive interest or behaviors later on) or is the child interested in things more generally. To do that, we really need to think about not the worst experience that the child has had, nor the best, but how the child is in general. When we keep these records with families, we want to be thinking about how the child behaves generally.

When to Start Screening for ASDs

We need to be thinking about doing developmental screening from a very early age—almost from birth—and doing autism-specific screenings at certain ages. At 18 and 24 months, the American Academy of Pediatrics[1] recommends that we start doing autism-specific screening so we can have those conversations with parents and use systematic data to ask, might this child go on to have autism?

You can use those screenings to help decide whether to say to a parent, "You should see a specialist." That would be, for example, a developmental behavioral pediatrician or a psychologist who is trained in the early diagnosis of young children. That's important because it falls to the specialist to make that diagnosis, and they can do that. You are shepherding that process because you have the records to show what the child has been like from a very early age. That's a crucial part of it.

I would like to leave you with the thought that we should all be doing developmental screening from a very young age. We should be thinking about the subtle clues of social engagement as another milestone that we want children to reach and assessing that in the same way that we assess language and motor development. And we want to be doing autism-specific screenings at 18 and 24 months, according to guidelines from the American Academy of Pediatrics, which lay out how screening should occur.

Help for Clinicians and Families: The Center for Autism Research

All of those things will help us make proper referrals and get children into early intervention even sooner. The sooner we begin early intervention, the better off all children will be. The Center for Autism Research has a website with a comprehensive list of resources, tips for parents and practitioners to help you through these difficult decisions. For families experiencing long wait times to see a developmental specialist for an evaluation, participating in a research study can be an alternate route for a developmental evaluation and clinical guidance. For a list of currently enrolling studies at the Center for Autism Research, visit www.centerforautismresearch.org/enroll. Check the Center for Autism Research website if you have any questions about how to talk to parents or to find out about the research that's going on, or if you need someone to talk to about how to talk to a family who is concerned. We're here to help.

Thank you.

Web Resources

Center for Autism Research YouTube channel

Video on early diagnosis and next steps

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