How to Share Concerns That a Child May Have Autism

What is Autism?

According to the Autism Navigator website, Autism (ASD) is defined as a neurodevelopmental disorder defined by persistent deficits in social communication and social interaction, accompanied by restricted, repetitive patterns of behavior, interests, or activities. Children with autism experience challenges in 3 areas:  communication skills, social interaction skills, and restrictive/repetitive behavior. 

Over the past several years we have seen a significant increase in the number of children diagnosed with Autism Spectrum Disorder (ASD). In 2022 estimates published by the US Centers for Disease Control indicate that approximately 1 in 34 children (4 years of age) are diagnosed with Autism Spectrum Disorder up from 1 in 44 in 2018.

I’ve have been seeing more and more children with characteristics of autism in Early Intervention. I know many evaluators are uncomfortable discussing these concerns with parents and don’t say anything, while others are unaware of the indicators. In any group of children with autism, no two children will have the same sets of characteristics. Some may make eye contact, while others may avoid eye contact. Some may have a minimal vocabulary, while others may recite whole phrases. It’s been said: “when you know one person with autism, you know one person with autism.”  This is so true!  Just because a child may or may not possess a certain skill or set of skills, does not mean the child has or ….does not have autism. Only a professional trained in diagnoses would be able to make this call.

Therefore, as the first step into diagnosis and treatment, it is important that Early Intervention evaluators are aware of the characteristics of autism and find ways to inform parents of their concerns.

Understandably, you need to know what to look for before you can recognize it.

So what do the characteristics of autism look like in young children?  While the list of characteristics I’m providing is thorough. it doesn’t include every characteristic. It is important to become familiar with different tools used to diagnose autism in order to see the full range of characteristics.

The following are some of the developmental differences found in toddlers and young children with autism:

Social Characteristics of Children with Autism

• Avoidance of eye contact or fleeting eye contact

• Doesn’t respond to a parent’s smile or other facial expressions

• Doesn’t point to objects or events to get a parent to look at them

• Doesn’t bring objects of personal interest to show to a parent

• Difficulty with using and understanding facial expressions

• Difficulty expressing their feelings

• Difficulty understanding the feelings of others

• Unable to make friends or is uninterested in making friends

• Doesn’t use toys or other objects to represent people or real life in pretend play

  
  

Communication Characteristics of Children with Autism

• Limited use of gestures such as pointing, showing, reaching or waving

• Loss of previously acquired speech

• Doesn’t respond to name

• Difficulty speaking or learning new words

• Repeats exactly what others say without understanding the meaning (often called echolalia)

• Has scripted speech

• Uses words to label objects and not make requests

• Doesn’t respond to name being called

• Seems to “ignore” but may respond to particular words and sounds

• May have a good rote memory, especially for numbers, letters, songs, TV jingles, or a specific topic

  
  

Behavioral Characteristics of Children with Autism

• Rocks, spins, unusual hand and finger movements, walks on toes or flaps hands

• Likes routines, order, and rituals; has difficulty with change or transition from one activity to another

• Obsessed with a few or unusual activities, doing them repeatedly during the day

• Plays with parts of toys instead of the whole toy (e.g., spinning the wheels of a toy truck)

• Engages in repetitive behaviors, such as opening and closing doors repeatedly or turning the lights on and off repeatedly

• High tolerance for pain

• Unusual use of vision or gaze—looks at objects from unusual angles

• Refusal to try new foods, new activities, or meet new people

  

  
  

What do you do if you suspect a child you are evaluating has Autism?

Informing a parent of your concerns is a sensitive matter and may be one of the most difficult parts of our role as evaluators. However, it is an extremely important role. We are the front line in getting children the services they need. Knowing the right recommendations to make and how to inform parents of these recommendations is crucial.

First of all, we are not in the position to diagnose, so we can’t mention that we feel a child has autism. If a parent directly asks you if you feel their child has autism, you can simply say you are not a professional licensed to make this diagnosis. The most we can do is describe the behaviors we see that are of concern. I used to use the words “red flags” to describe these indicators. However, this term has come under scrutiny lately and members of autism groups suggest using terms such as signs or indicators instead.

Moreover, describe how the child’s behavior is impacting their learning and development. Give clear examples, “Since Jenny doesn’t respond when you call her name, pay attention when you point things out to her and try to teach her things, she is not learning age level concepts, etc.”

It’s important to use simple, straightforward language and be empathetic. Always start off on a positive note. “Mike is always smiling and seems very content.” Put yourself in the parents’ shoes. How would you want the information explained to you if you were the parent? If you are uncomfortable doing this alone, set up another meeting with the parent and your supervisor.

At times, a parent may become defensive and not want to hear what you have to say. If that happens, let the subject go and follow up at another time or have someone else on the team follow up. Keep in mind, the most we can do is make recommendations. It is up to the parent to follow through with them. Don’t take it personally if they don’t. They just may not be ready to hear that their child has autism.

Finally, let the parent know what the next steps are depending if they accepted or declined further assessments. Reassure the parent that you are on their team and have their child’s best interests at heart.

Where can you get more information about Autism?

Here are some websites that you may find useful in understanding ASD.

• Centers for Disease Control and Prevention: The Act Early website contains an interactive and easy-to-use milestones checklist for children ages three months through five years that you can share with parents as well as other tips and free materials.

• First Signs: The First Signs website contains a variety of helpful resources related to recognizing the first signs of autism spectrum disorder, and the screening and referral process.

• Autism Navigator Video Glossary: To learn more about how ASD symptoms present in children of different ages, explore the online educational modules, which include videotaped examples of children with and without ASD, and much more.