How early can you detect the first signs of autism?
Parents want to know as early as possible if their child has autism, especially if they already have a child with autism. Children with a sibling who has an Autism Spectrum Disorder are considered to be at a high risk, up to 7%, of also being on the autism spectrum2,4.
Parents are in the ideal position to observe their child in all his moods and situations, and at a variety of times during the day and night. With some training, you can play an active partnership role with your family doctor or pediatrician to observe and record your child’s development.
Included in this article, you will find four simple tests you can do at home when your child is as young as two months old. These tests will give you real numbers that you can share with your doctor at your child’s next developmental checkup.
The American Academy of Pediatrics recommends that all children be screened for developmental delays and disabilities during regular doctor visits at 9 months, 18 months and 24 or 30 months.
Symptoms of Autism in Young Children
With babies and toddlers, the symptoms of autism are about what the child does NOT do at a typical age. The symptoms listed below happen at a variety of ages, but they are all things that child with potential autism may NOT do. These symptoms include:
- Child does not make eye contact (e.g. look at you when being fed);
- Child does not smile when smiled at;
- Child does not respond to his or her name, or to the sound of a familiar voice;
- Child does not follow objects visually;
- Child does not point or wave goodbye, or use other gestures to communicate;
- Child does not follow your finger when you point at things;
- Child does not make noises to get your attention;
- Child does not initiate or respond to cuddling;
- Child does not reach out to be picked up.
Eye contact and social skills in young children with autism
In the past decade, research has intensified on the study of gaze and eye contact in high-risk infants. In particular, researchers have examined behavioral markers in young infants such as smiling and visual attention during face-to-face interactions1,6.
Social engagement skills are intact after birth in children with autism and the decline of these skills is often one of the things that parents notice as a potential marker for autism3. By the age of two years old, the children in a 2006 study who were later diagnosed with autism showed significantly worse performance in visual reception than their typically developing counterparts7.
Four simple eye-tracking tests to check autism warning signs
Your pediatrician or family doctor will be better prepared to assess your child for autism if you can share specific, measurable examples with him or her.
The tests described below are intended to help parents focus on their baby’s gaze, since this has been identified as a specific indicator for potential autism3. These activities are appropriate for infants between two and nine months old.
1. Object and image scanning
Show your child two objects: 1) a colorful painting and 2) an interesting object, e.g. a rattle. Hold one thing in each hand, with your hands about two feet apart. You should be about one foot (30 cm) away from your baby’s face. Your baby can be lying down or sitting in a recliner or high chair.
Count how many times your child scans between the object and the picture in one minute.
You may consider repeating this test over a period of a few days and noting the average number of scans.
Generally, you should expect a typically developing infant to scan between four and eight times per minute. The older the child, the more times he/she should scan between the two objects5.
2. Object and sound
Try this activity when your baby is in a recliner or high chair. You will need an interesting object (e.g. a stuffed toy or piece of art) and a small bell. If you don’t have a bell, you can also hit a glass with the side of a spoon, to make a distinct but pleasant ringing sound.
Show the object to your child and while he/she is looking at it, ring the small bell with your other hand so that the sound comes from another direction. Your baby should not be able to see the bell; you could hide it behind your back or have someone else ring the bell.
Wait until your baby turns his/her head to find the source of the bell sound.
Note the following:
- How often does your baby turn to check the source of the sound?
- If he/she turns toward the sound, for how long did you have to shake the sound maker before your baby turned towards the sound?
Again, consider doing this test a few times and writing down the average number of times that your baby turns towards the sound.
Generally, you should expect a typically developing infant to turn toward the sound within two to three seconds. The older the child, the more quickly he/she should be able to disconnect from the first object and turn toward the bell sound5.
3. Social Engagement
(This test requires your child to be at least three months old.)
Face your baby, keep a neutral face, then make a big smile.
If you do this four times in a row, keeping each smile for five seconds, how many times does your baby smile back at you?
Generally, you should expect a typically developing infant to smile back every time5.
4. Following a red object
Lay your baby on his/her back and place a pillow on each side of the baby’s head, so that he/she can’t turn his/her head from side to side very much.
Hold a red ball in your hand and move it slowly from left to right and back again about one foot away from the baby’s face.
What is the distance, approximately, that your baby follows the ball’s movement with his/her eyes? If you do this four times, how many times does baby follow the ball, even if he/she scans only a small distance?
Generally, you should expect a typically developing infant to scan and follow the object with his/her eyes (without moving his/her head) all the way to about a foot to the left and to the right. The older the child, the more smoothly he/she will be able to scan without any blinking or jumping5.
These tests are not meant as self-diagnostic tools for autism, but they should equip you with useful, objective measures that will greatly help your child’s doctor to determine whether your child requires further evaluation.
- Cassel, T. D., Messinger, D. S., Ibanez, L. V., Haltigan, J. D., Acosta, S. I., & Buchman, A. C. (2007). Early social and emotional communication in the infant siblings of children with autism spectrum disorders: an examination of the broad phenotype. Journal of Autism and Developmental Disorders, 37(1), 122–132.
- Grønborg, T. K., Schendel, D. E., & Parner, E. T. (2013). Recurrence of autism spectrum disorders in full- and half-siblings and trends over time: a population-based cohort study. JAMA (Journal of the American Medical Association) Pediatrics, 167(10), 947–953.
- Jones, W., & Klin, A. (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, 504(7480), 427–431.
- Mulligan, S., & White, B. P. (2012). Sensory and motor behaviors of infant siblings of children with and without autism. The American Journal of Occupational Therapy: Official Publication of the American Occupational Therapy Association, 66(5), 556–566.
- Ormrod, J.E. (2007). Human Learning (5th ed.). Upper Saddle River, NJ: Merrill/Prentice Hall.
- Young, G. S., Merin, N., Rogers, S. J., & Ozonoff, S. (2009). Gaze behavior and affect at 6 months: predicting clinical outcomes and language development in typically developing infants and infants at risk for autism. Developmental Science, 12(5), 798–814.
- Landa, R., & Garrett-Mayer, E. (2006). Development in infants with autism spectrum disorders: a prospective study. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 47(6), 629–638.