Early Detection of Autism in Infants and Toddlers (Part 4)
The process of learning to orient to one’s own name involves aspects of both social and communication domains as well as attention (Werner et al. 2000), and therefore, difficulties in responding to this specific vocalization indicates a broad range of dysfunction. Potentially a powerful estimate of impairment on the autism disorder spectrum, typically developing infants orient to their name being called approximately seventy-five percent of the time, whereas only thirty-seven percent of autistic infants oriented to their names between the ages of eight and ten months using retrospective home video footage in a study by Werner et al. (2000). Fewer differences were noted in terms of social response to name calling than in the Osterling and Dawson study (1994) of infants at one year of age, perhaps due to the fact that between nine and twelve months of age, many new behaviors are just beginning to develop. Although many complex social, emotional, and communicative behaviors emerge during the eight to nine months of life, skills within these categories do not begin to solidify until after the age of one.
Joint Attention as a Predictor for Social Impairment
The previous example of response to name calling in very young children also draws upon the difficulties that most autistic infants experience in their development of joint attention skills. During the first year of life, children with autism spectrum disorders may fail to follow a point and in many instances, will not gaze switch between interesting objects and an adult’s face or coordinate responses to emotional displays by an adult (Charman, Baron-Cohen, Swettenham, Cox, Baird, & Drew, 1997). Moreover, gaze monitoring in joint attention, which provides relevant information concerning interests and dangers in the environment, is essential for the active participation of social learning opportunities for all infants (Charwarska, Klin, & Volkmar, 2003). As such, deficits in spontaneous gaze monitoring are widely recognized at this point in current research as early signs of autism, although we are unaware of the neurological mechanisms to produce these problems. Kalb has determined through eye-tracking technology that when affected toddlers view the videos of their caregivers or other babies within the same nursery of which they are familiar, they tend to focus more on the individual’s mouth or an object located directly behind the individual than his or her eyes (2005). This finding was confirmed when Charwarska et al. demonstrated in 2003 that although face recognition improves with age in those with autism, older individuals employ feature-based rather than holistic strategies in face processing, and therefore, “recruit different neural substrates in face processing than their typical controls,” (1985).
In terms of pointing behavior, typically developing children will follow a pointed index finger when they have achieved a developmental level of twelve months old, but children with autism from the time they are born are significantly less likely, according to Young et al. to switch their gaze as a means of following a point by another individual (2003). Despite these findings, many infants with autism at two years of age show intact performance relative to typically developing controls in the area of nonsocial use of gaze to obtain information about objects and the environment surrounding them. Charman et al. suggest that these abilities remain intact in those with autism although social gaze is not initiated because they are not a feature of the central social communicative deficit in autism (1997). This discovery asserts that there may indeed be a key difference between the growth of social and nonsocial use of gaze in broad development of all infants.
Imitation and Pretend Play
Significant delays in the production of imitation in very young infants as well as pretend play schemes in their slightly older counterparts are important warning signs to monitor in developing criterion for early assessment strategies. Imitation by typically developing and developmentally delayed infants is not merely a superficial repetition of movements made by another person but is instead a complex tool for developing interpersonal relationships with parents (Trevarthen & Aitken, 2001). Trevarthen and Aitken continue in this explanation in stating, “[imitation] is, even for newborns, an emotionally charged mutual influence of motive states in which certain salient expressive actions of the other are identified and repeated to further an ongoing communication,” (2001). A study by Charman et al. produced confirming results in suggesting that although basic level of imitation is apparent in school-age children with autism, those under the age of twenty months show considerable difficulty and unresponsiveness in this area (1997). After the mastery of a significant degree of gross and fine motor skills has been obtain through imitation, most children will begin to establish play activities progressing from simple object exploration to functional object use and finally pretend play. Between the ages of nine and twelve months, however, distinguishable abnormalities become evident and progressively more deviant in those with autism spectrum disorder in comparison to typically developing peers (Volkmar et al. 2005). In this same study, it was determined that by the second birthday of many children with autism, differences in functional play abilities and routines are striking, particularly in terms of purposefulness, symbolism, and complexity (Volkmar et al. 2005). As functional play ability continues to be impeded throughout the early years of life, pretend play is further hindered, and thus, many children with autism do not begin to develop a concept of such imaginative behavior until they have been taught specific strategies and skills within an early intervention setting (Charman, Swettenham, Baron-Cohen, Cox, Baird, & Drew, 1998).
Implications of Early Diagnosis
Early detection and diagnosis of autism in young infants may be crucial to the future outcome of these individuals because early behavioral intervention has been shown to provide a substantial impact on the long-term prognosis (Osterling et al.