At this very moment, thousands of infants and toddlers throughout the United States exhibit worrisome behavior. They are being managed by perplexed parents and remain unclassified by family practioners, but the developmental outcome of these very young children may brighten as the early diagnosis and consequential expedience of intervention becomes a reality. Anecdotal reports imply that children diagnosed with autism display characteristics of abnormal behavior at an early age, possibly from birth, and in fact, this early onset of such behaviors (prior to thirty-six months) is a diagnostic criterion (Young, Brewer, & Pattison, 2003). According to Trevarthen & Aitken, (2001) fifty percent of parents of children with suspected autism report a strong suspicion of abnormal development prior to the age of one. However, as Kalb asserts, most children will not even be seen by specializing clinicians until they have reached their second birthday with many of these waiting on the appropriate diagnosis until at least the age of three (2005). Further research suggests that anywhere between thirty-one and fifty-five percent of children with autistic disorder show at least some defining behavioral characteristics in the first year of life, and seventy-five to eighty-eight percent have some of these abnormal responses by the first two years of life (Young et al. 2003). For example, in this same data analysis conducted, it was determined that despite these qualitative and quantitative differences in development, the average age of diagnosis for children living in the United Kingdom in 1994 was not until forty-four months even when parents became first concerned about their child’s development at an average age of seventeen months (Young et al. 2003). Additional research has demonstrated a lag between twenty-four and thirty months from the first expression of apprehension by parents about their child’s development to the actual obtainment of a diagnosis.
Over the past decade, researchers have been working toward increasing the accuracy and sensitivity for the interpretation of minute behavioral characteristics in distinguishing autism from the typically developing population. As part of a ten year plan, the National Institute of Mental Health has set the goal of actually “reducing the frequency of autism in school-aged children through early diagnosis and intervention,” (Volkmar, Chawarska, & Klin, 2005). To do this, diagnostic criteria must be tweaked to accommodate the earliest observable behaviors of this disorder. The current definition outlined by the DSM-IV-TR was not researched for children under the age of three, and therefore, is clearly not applicable to toddlers and infants, particularly involving criteria for peer relationships and conversational skills (Klin, Charwarska, Paul, Rubin, Morgan, Wiesner, & Volkmar, 2004). As stated by Young et al. “Many of the behaviors included in [this] classification system relate to secondary behaviors often developed to compensate for underlying neurological deficits,” (2003). For example, stereotyped behaviors such as adherence to routines and rituals are much more common in older children and are rarely noted in children under two years of age. In this paper I will review the observed signs and symptomology reported by parents, observed during clinical diagnostics, and investigated within in the research setting of very young children with suspected autism spectrum disorders.
Parental Observations of Early Symptomology
Parents are often the first to become aware of behavioral deviations their children display from the expected norm, and as a result, these observations become critically vital for the development of early diagnostic tools in clinical evaluation. In a study conducted by Young et al. in 2003, the researcher found the mean age in which parents first notice abnormal developmental signs to be approximately 15. 1 months with a standard deviation of 11. 2 months. Ninety-five percent of these same parents noted anomalies in social development by the age of two. By their first birthdays, children have been noted by their parents to show patterns of extreme reactivity, either getting upset when a new toy or activity is presented or barely noticing this novelty at all. In case reports of classic autism, parents often report their babies have failed to coo or babble by their first birthday or words that they have developed inexplicably disappear (Kalb, 2005). A substantial proportion of others also exhibit repetitive behaviors characteristic of autism such as rocking back and forth or becoming fixated on an object, as well as unusual preoccupations and stereotypy emerging around twenty to thirty months (Kalb, 2005). Parents predominantly report that speech delays or worries about hearing are common concerns, and also may worry that their child is too well behaved or is highly irritable (Volkmar et al. 2005). Additionally, infants with autism may display limited eye contact, diminished social responsiveness, and show little facial expression. Children may be less likely to engage in motor or vocal imitation and are more likely to exhibit difficulties in regulating arousal levels and organizing sensory responses.
By thirty months, Volkmar et al. determined that differences from typical peers in areas of “both person-to-person behaviors (anticipatory postures, turn taking, intensity of eye contact)” and “behaviors in which an object is the focus of joint interest (joint attentional skills such as pointing to materials, following a point of another person, or giving objects),” (2005) have become readily apparent to many adults the children interact with, particularly parents. A minority of children with autism, however, (approximately one in five) show a normal course of development during infancy but begin to lose or regress in social and communication skills and instead manifest autistic symptoms of attention and preservative behavior between the ages of eighteen and thirty-six months (Osterling, Dawson, & Munson, 2002). This and other variations in the acquisition of symptomology of infants and toddlers with autism present significant difficulties in relying solely on parental observation, and thus require further evaluation and scientific study by trained clinicians.