Disabled moms
Autism
Timmy was the perfect baby. Quiet and complacent, at 10 months he could play by himself for hours, allowing me to read the paper or do the housework. Unlike our friends' children, Timmy was so much less demanding of our attention. We just assumed he was very bright and independent. We began to worry, however, when his older sister celebrated her 4th birthday, and Timmy was only a year old. With all the friends and relatives around, he suddenly seemed withdrawn, preferring to crouch in a corner by himself, and at times crying as if there was too much commotion for him. Over the next several months, we began to notice other signs that concerned us. Timmy seemed not to notice our comings and goings as much, and by 18 months, still had not spoken a word. We talked to our pediatrician, but were told that he was likely just a little slow to talk-boys often are, and he has a big sister who likes to do things for him. When Timmy still was not talking at 2, we began to look for other help....Although autism is usually diagnosed when the child is 3 to 4 years old, parents like the mother above often sense that something is wrong much earlier. On average, parents start to worry about their child's development by 18 months of age and voice some of their concerns to a doctor or another professional by age 2.
But physicians and professionals are hesitant to diagnose autism at very early ages. They know that the early development of children varies, and are often uncertain if a behavior will persist into being considered atypical, or if behaviors that should be present will continue to be absent. If the child is labeled with a problem too early, parents may reduce expectations for the child and restrict the child's access to typical experiences and opportunities. Thus, professionals may take on a "wait and see" stance that delays diagnosis, and ultimately the commencement of intervention services.
Although such concerns are valid, the benefits of early diagnosis
vastly outweigh the risks. These benefits include the relief parents may
feel in having their concerns validated, and in their ability to address
the problem as early as possible. As many studies have now shown, early
intervention is critical for the best outcome in children with autism,
and many believe the earlier the better. Only with a diagnosis can
parents begin to obtain necessary intervention services for their child.
Given the potential benefits of early diagnosis, is it possible to
reliably diagnose autism before age 2? The answer is yes. A number of
researchers have now studied the early development of children with
autism-a not so easy task given that the average age of diagnosis in the
United States is 3 to 4 years of age.
Early development of children with autism has been studied by:
* screening large numbers of children for autism-specific behaviors
during well-baby checks at 18 months of age;
* asking parents of children with autism to remember back to
whether their child showed certain behaviors at certain developmental
ages;
* and having parents bring in home videos of children diagnosed
with autism when these children had their first or second birthday
parties (which parents often videotape).
From these studies, five distinct areas of development are flagged
for consideration. All parents should consider these "Big
Five" if they suspect that their child may have autism.
1) Does the baby respond to his or her name when called by the
caregiver? Within the first few months of life, babies respond to their
own name by orienting toward the person who called them. Typical babies
are very responsive to the voices of familiar people, and often respond
with smiles and looks.
In contrast, infants later diagnosed with autism often fail to
respond to their own name. That is, when called by name, they tend to
turn and look at the person only about 20% of the time as found in the
videotaped one-year-old birthday parties of children with autism. They
also are often selectively responsive to sounds. They may ignore some
sounds and respond to others that are of the same loudness. Thus, they
may fail to respond to their parent calling their name, but immediately
respond to the television being turned on. It is not unusual for parents
to suspect their child has a hearing loss.
2) Does the young child engage in "joint attention"? Near
the end of the first year of life, most infants begin to join with their
caregivers in looking at the same object or event. To aid in this
process of "joint attention", typical infants begin to shift
their gaze from toys to people, follow other's points, monitor the
gaze of others, point to objects or events to share interest, and show
toys to others. These behaviors have a distinct sharing quality to them.
For example, the young infant may point to an airplane flying over head,
and look to the parent, as if to say, "do you see that!"
In contrast, young children with autism have particular
difficulties in jointly attending with others. They rarely follow
another's points, do not often shift their gaze back and forth from
objects to people, and do not seem to share "being with" the
caregiver as they watch and talk about objects, people, or events. They
also tend not to "show" a toy to the parent.
3) Does the child imitate others? Typical infants are mimics. Very
young infants can imitate facial movements (e.g., sticking out their
tongue). As early as 8-10 months, mothers and infants say the same
sounds one after another, or clap or make other movements. Indeed,
imitation is a major part of such common infant games as pat-a-cake and
So Big ("How big is baby? Soooo big!" as infant raises hands
to sky).
Young children with autism, however, less often imitate others.
They show less imitation of body and facial movements (waving, making
faces, playing infant games), and less imitation with objects.
4) Does the child respond emotionally to others? Typical infants
are socially responsive to others. They smile when others smile at them,
and they initiate smiles and laughs when playing with toys and others.
When typical infants observe another child crying, they may cry
themselves, or looked concerned. Somewhat older infants may crawl near
the person, pat, or in other ways offer comfort. These latter behaviors
are suggestive of empathy and are commonly observed among children in
the second year of life.
In contrast, children with autism may seem unaware of the emotions
of others. They may not take notice of the social smiles of others, and
thus may not look and smile in response to other's smiles. They
also may ignore the distress of others. Several researchers have now
shown that when an adult feigns pain and distress after hitting herself
with a toy, or banging her knee, young children with autism are less
likely to look at the adult, or show facial concern.
5) Does the baby engage in pretend play? Someone once noted that
"play is the work of children." Young children love to
pretend-to be a mother, father, or baby, to be a firefighter or police
officer. Although children start to play with toys around six months or
so, play does not take on a pretend quality until the end of the first
year. Their first actions may involve pretending to feed themselves,
their mother or a doll, brush the doll's hair, or wipe the
doll's nose. Nearer their second birthday, children engage in truly
imaginative play as dolls may take on human qualities of talking or
engaging in household routines. Children may pretend that a sponge is a
piece of food, a block is a hat, or a plastic bowl is a swimming pool
that contains water.
In contrast, the play of children with autism may be lacking in
several ways. The young child may not be interested in objects at all,
paying more attention to the movement of his hands, or a piece of
string. If interested in toys, only certain ones may catch his interest,
and these may be used in a repetitive way that is not consistent with
how most children would play with the toy. They may be more interested
in turning a toy car upside down and spinning the wheels than pushing
the car back and forth. Overall, pretend qualities are nearly absent in
the play of children with autism under 2 years of age.
It is important to note that in each of the 5 areas we have
flagged, we are most concerned with behaviors that are absent or occur
at very low rates. The absence of certain behaviors may be more
difficult to pinpoint than the presence of atypical behaviors. But
concerns in any of the above areas should prompt a parent to investigate
screening their child for autism. Several screening measures are now
available, and information from the screener will help to determine if
the parent should pursue further evaluations. If the parent is convinced
their child has autism, then they should seek an evaluation with an
expert in autism. Most likely, this evaluation will involve an interview
with the parents to obtain a complete developmental history of the
child, and direct observations of the child in different situations.
Luckily, Timmy and his parents were able to get the diagnosis of
autism before Timmy's third birthday. They began intensive
treatment with Timmy, and he made immediate progress. They are hoping
for the best outcome, and feel confident that his early diagnosis was
critical in getting him the help he needs to reach his potential.
Dr. Connie Kasari is a Professor in the Division of Psychological
Studies in Education in the School of Education & Information
Studies at the University of California, Los Angeles. She has engaged in
research on children with disabilities for over 20 years, and currently
has two federally funded projects on interventions with young children
with autism and their families.
Connie Wong is a doctoral student in the Division of Psychological
Studies in Education at UCLA. Her interests are in preschool-based
services for children with autism, and the effectiveness of different
teaching methods with these children.
|
More Information |
|
|