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The ABCs Of ASD: Understanding Autism Spectrum Disorder in children

Gita Srikanth Gita Srikanth 8 Mins Read

Gita Srikanth Gita Srikanth


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Here's what two experts have to say about autism, its signs and symptoms, the importance of early intervention, and finding the support you need

Toddler to Pre-teen
The ABCs Of ASD: Understanding Autism Spectrum Disorder in children

What's the first word that comes to mind when you hear the words "autism" or "autism spectrum disorder"? Minimal eye contact, socially withdrawn, loner, different, savant, mathematician, awkward, little professor or puzzle? Autism spectrum disorder (ASD) includes a group of neurodevelopmental disorders that manifest as difficulties in social communication, repetitive behaviors and restricted interests.

Common signs of ASD

The symptoms impact the development and comprehension of language and communication in a big way, affecting many areas of functioning, including academic progress and interactions with peer group. There's a saying that if you've met one person with ASD, you've only met one person with ASD! The symptoms may vary from person to person. That being said, there are some common signs and symptoms. These include (but are not limited to):

  • poor eye contact
  • inconsistent response to one's name
  • inadequate imitation skills
  • delayed development of spoken language
  • loss of previously acquired language skills, if any
  • impaired play skills
  • little interest in peer interaction
  • adherence to routines
  • restricted, seemingly strange interests

Some children on the spectrum have echolalia or the ability to repeat words that they hear. But they're often unable to use the same words when they need something. We have come across children who can name all the vegetables and fruits and even the people living in their house, but when they want a snack, they are unable to find the words and communicate their wants. The sheer number of words in a child's vocabulary fails him when he needs to use the words to obtain what he wants!

Red flags of ASD in toddlers

What are some of the red flags to watch out for?

12 months: If an infant by 12 months is not babbling or using communicative gestures like waving or pointing, then there's cause for concern. "Pointing" in itself is a very misunderstood skill by parents and even practitioners. A typically developing child will point to what she wants even if she doesn't have the words for it. This is a skill that is often missing in a child with autism-and the deficit is plugged by teaching the child to point to everything. Unfortunately, it's still not communicative pointing, because the very concept of meaningful and socially appropriate communication is missing. Many children on the spectrum point toward an object of interest, but do not refer back to the adult, while they continue to point to convey that they want that particular item.

24 months: If by 24 months, a toddler does not have a bank of meaningful or intentional two-word phrases, then there's definite cause for concern. If your toddler has trouble playing with children his age but accepts being around older children and adults, there's cause for concern. If he doesn't engage much in imaginative play and shows little interest in sharing objects of interest and sharing emotions, you may have to take your child to a developmental pediatrician. If your child has temper tantrums for seemingly irrelevant reasons, if his obsessions change form with time and move from watching the fan spin to opening and closing doors or straightening furniture, you know you need a review with your developmental pediatrician.

36 months: If by 36 months, your child is not speaking in sentences, if he has restricted interests, he babbles or uses only one word, and he pulls your hand or your dress or cries to get what he wants, you know you need to meet an autism and developmental specialist. As a parent, your first instinct is always right, but that's often suppressed by well-intentioned advice from family that boys speak late or that somebody in the family spoke only after he turned 4 and grew up to be a brilliant engineer or lawyer.

The classic portrayal of autism is one of an isolated child, playing by himself with little or no response when spoken to and absolutely no eye contact. Autism presents in many ways, and children on the spectrum may not always display the classic signs we discussed earlier. The Wikipedia definition is not always met anymore. In the course of our many consults, we have met with children who can speak lengthy sentences, children who cannot speak a single word, children who are partly verbal, children who have fantastic eye contact and children with limited eye contact, all meeting the criteria for ASD.

Children with autism might often seem like they are deliberately disobedient. Parents observe that they learn some things very quickly, while they never seem to understand or pick up certain other skills for the longest time. They may say some words once, but will never repeat those words on instruction. "Stubborn" is the word that many parents use to describe their child with ASD. While in reality, this dichotomy arises due to impairments in the areas of communication and social interaction. And then there is motivation. That is a big factor in learning and accounts for the fact that the child learns certain skills that revolve around making his life easier or that give him access to things he wants.

Diagnosis and parental counseling

One of the things that surprise parents about the diagnosis of autism is the seemingly typical development of the child. The child looks fine, has full use of his limbs, can see and can hear (when the child does not respond when called, parents often suspect hearing loss). Parents also try to understand where the disorder came from and many of them wonder why their child has autism when there's nobody in the family with a similar diagnosis. And of course, there's often guilt, especially among mothers. Was it too much exposure to phones and laptops? Did she not spend enough time with the child? Did she not talk to him enough? Maybe she should have quit her job!

Most parents visit their pediatricians with their concerns, and the pediatricians may refer them to a neurologist or a psychiatrist for evaluation. The diagnosis of autism is made using standardized assessments including the ADOS-2 (Autism Diagnostic Observation Schedule-2), the ADI-R (Autism Diagnostic Interview-Revised), and the CARS (Childhood Autism Rating Scale), which are administered by trained clinical psychologists, developmental pediatricians, psychiatrists or board-certified behavior analysts (BCBAs). The diagnosis is made by the presence or absence of certain behaviors, making parental inputs and the interactions with the child critical aspects of the diagnostic process.

The next step after diagnosis would certainly be parental counseling to help the parents understand the implications of the disorder, what it means for the child, what it means for the family and the way forward. Time spent on parental counseling is time well-spent in helping the beginning of acceptance and intervention.

Intervention and parental training

There are many forms of intervention for autism, some evidence-based, many that are not based on evidence. There are interventions that become popular by hearsay or through success stories on digital media. The child needs early intensive intervention to start with, which can improve her language, play and imitation skills. These interventions lay the foundation for the development of communication and social skills in the child. Parent training is also critical so that parents become stakeholders in the process and are empowered to understand their child and her behaviors on a day-to-day basis. After all, parents know their child better than anyone else. Besides, they have a natural bonding with their child, making it easier to start working on communication and play. Home also provides the child with ample natural situations to ask for things she wants, thereby helping in establishing the foundation for communication.

In a nutshell

  • Autism is a lifelong disorder.
  • The focus should ideally be on enabling over fixing.
  • Always keep the child's perspective in mind as a guide to intervention.
  • Question interventions, question methodologies, look up evidence! You as a parent have every right to make informed choices for your child.

What you can do

  • Accept, accept, accept! Your child DOES NOT HAVE to fit in. Don't make him someone he is not. He is unique and beautiful just the way he is. As the beloved children's author Dr Seuss said, "Why fit in when you were born to stand out?"
  • Hold his hand and walk together, the journey that awaits is a beautiful one!

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