Is it autism? Signs and where to get help

Tanya and Paul were understandably concerned parents. They were referred to me as their two-year-old son, Tom, was showing unusual behaviour. At home, he preferred to be left alone and never made eye contact. Even at daycare, he played on his own and showed no interest in others. When he spoke (which was rarely), it was often with one-word utterances that made little sense, and when he played, it was always with the same truck that he pushed in a repeated pattern.

Tom hated change and screamed and rocked when anything unexpected occurred. He seemed very sensitive to noise and touch, too. After an intensive assessment, a diagnosis was made that Tom had autism.

His mother was worried his behaviour started after immunisation, but when we watched home videos of Tom as a
baby, we could see he was very stiff and non-affectionate when Tanya tried to cuddle him. In fact, no one could hug him. The videos also revealed that Tom didn’t interact at all as a baby. He didn’t point or smile at his parents, and showed no sign of crawling at 16 months. Also, there is no proof that any vaccinations are a cause of autism Article: For and against immunisation

A growing concern

Around one in every 160 Australian children are diagnosed with an ‘autistic spectrum disorder’ (ASD). Some are diagnosed with autism, others with a milder, alternative form of ASD called Asperger’s syndrome.

While the exact cause of autism is unknown, there has been a marked increase in diagnosis, partly as professionals are better at identifying and diagnosing it. Recent research suggests genetics may also be playing a large role in increasing rates of autism.

Autism is preferably diagnosed before the age of three years. Diagnosis is often later for toddlers with Asperger’s syndrome, as symptoms are not as clear or severe. At the risk of generalising, toddlers with autism don’t want to socialise, have delayed language skills, don’t interact and have very obsessive rituals. On the other hand, toddlers with Asperger’s syndrome tend to want to socialise but don’t know how, have unusual social behaviour and odd language skills (such as repeating phrases) and have less-fixated rituals and obsessions.

As toddlers develop, all groups in the autistic spectrum may show similar sensory problems, such as being very sensitive to touch, smell, taste or sounds. They also tend to be very rule-bound and determined to follow certain patterns of behaviour or routines. As a result, they get very upset with any changes or transitions.

As other toddlers begin to develop empathy, at around three or four, the inability of ASD children to understand the emotions or needs of others becomes more apparent. Behaviours such as an unwillingness to share, pushing others to always be first or demanding to get what they want become more obvious, while others, such as reciprocal play (like helping in return), do not develop.

Toddlers with autism may self-injure at this time, with biting for example, or may totally withdraw to a hiding place. Toddlers with Asperger’s syndrome might begin very repetitive behaviours to cope or block the world out, such as pacing in circles. As language develops, both groups are noted to be very literal in their interpretation of language. For example, when Tom was told, “Pull your socks up and behave”, he literally stopped to pull his socks up. When he realised he had none on, he ran away and hid, as he didn’t know what to do.

Girls often develop language and social skills earlier than boys, which possibly explains why boys are more likely to be diagnosed, and diagnosed earlier, with an ASD than girls. Interestingly, diagnosis rates for boys and girls are closer to equal within the more severe forms of autism, referred to as ‘low-functioning autistic disorders’, but it is more common for boys to have Asperger’s.

Help is at hand

The good news is that there’s great help available for toddlers with autism.

However, early diagnosis and treatment is critical. Understandably, many parents can be in mild denial, so a gentle starting place is the Autism Association within each state, which can provide useful information. From here, parents can discuss concerns with their local doctor, who can refer them to a paediatrician or child psychologist experienced in diagnosing and treating toddlers with ASDs. Other specialists are making huge gains with ASD management, including speech pathologists, occupational therapists using sensory integration methods and other professionals utilising social skills programs. New research is also looking into the benefits of environmental factors, such as diet.

With early treatment, gradual and positive gains can be made. Toddlers like Tom will need a good amount of
treatment, but already he is developing a broad range of skills and showing great potential. Indeed, many of the toddlers I first saw over 20 years ago now lead normal, happy lives.

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