With Autism in the news in abundance today, it is becoming a household name. Although we still have so many more questions about Autism, we know a great deal more than we did even ten years ago. In my line of work in the field of Early Intervention, I provide play therapy to delayed and disabled children ages birth to three years old, and we have had many children come in and out of our program who have had a diagnosis of an Autism Spectrum Disorder. Often times because we work with such a young population, we are the first to suspect a child may warrant this diagnosis and so the responsibility is placed on us to provide information to the parents. The literature out there is great on Autism, but I have yet to find an article that is truly parent friendly in it’s explanations, with every day examples of typical characteristics that a child with Autism may display. Here I will explain in some detail many of the characteristics a toddler with Autism Spectrum Disorder may have.
It’s not uncommon that I’ll have a parent of a child with a language delay come to me with concerns that their child could be Autistic. If your child has a language delay, that does not mean that they absolutely are Autistic. They could just simply be late in talking. However, many children with an Autism diagnosis are language delayed. There are two areas of language. Expressive language is how a child is actually trying to express themselves to you. This can be in the form of spoken language, or it could be sign language or body gestures to try to let you know what it is they want or need, such as pointing to an item. Receptive language is what a child actually understands. This will include following directions, pointing to an item when asked (i.e. “where’s the dog?”), and simply reacting to their name being called.
For a child with Autism, expressive language can be a challenge. Many children with Autism are delayed in the area of language simply because they are not yet talking. You may hear some babble sounds (i.e. “ba ba”) that don’t tend to mean anything, but few, or no real words. If the child with Autism does indeed talk, their language could be a bit disordered. A typical example of this would be a child who has many words and is talking all day long, but you don’t really know why they are saying such things, where they have learned them, or what they mean. For example, I’ve worked with a little two-year-old boy, who would be playing and would repeat these catch phrases such as “it’s a home run!” although he was talking to no one in particular and he was intently playing with a train at the time. He would just say this phrase three or four times before he was finished. He could very well have picked this phrase up from his parents, or he could have learned it from the television. At times, he would have new catch phrases that I would have to ask his mother about, and she was often times unaware of where her son had learned them. At times, she’d touch base with me a week later and saw a phrase he had been saying on one of his favorite television programs, for example. It’s absolutely wonderful that this little boy was talking! Yet, the difference here, is that it was not reciprocal communication. He was not looking at his mother and talking to her, asking her for something, or telling her what it is he wanted or needed at the time, and then waiting for her response. She was unable to ask him a question and have him reply.
Echolalia is another form of disordered language. Echolalia can absolutely be a typical form of learning for a child. It is simply when a child repeats what they have heard. Say, for example, I say “these are blueberries.” For a child to then look at you, look at the blueberries and say “blueberries” is wonderful. This is how they are learning their new words to add to their ever-increasing vocabulary list. Yet, if you say the same thing, “these are blueberries,” and have a child avoid your gaze and say the exact same thing back to you, “these are blueberries,” although it is wonderful that they are speaking, this is not entirely meaningful language. They are not picking up on how to actually use this language to communicate with others. They are simply repeating what it is they have just heard. The chances of this child picking up a blueberry, looking at you, and saying “blueberry” are slim. This is echolalia at it’s best with a child with Autism.
Receptive language (understanding spoken language) is another area of development that can be very difficult for a child with Autism. Before a child is even a year old, they should be able to look in your direction when their name is called. Often parents of a child with Autism will assume they are not reacting to their name being called because of a hearing loss. They will then get their child’s hearing tested, and almost always, the results are within normal limits. It is just simply a characteristic of Autism. They have a very difficult time understanding spoken language. Often, they will not follow simple directions such as “go get your shoes,” or “go give this to Daddy.” They may not be pointing at pictures in a book or pointing at familiar items in their environment if you ask them to do so. Even if a child looks at a ball and then labels it, saying “ball,” you may notice that later in the day when you try to get your child’s attention and then say “where’s the ball?” they may not point or make an effort to get the ball. By a year old, a child should be able to look to familiar people when they are named. By approximately 15 to 18 months, they should be able to point to a few body parts when asked to do so. These are receptive language skills.
Another very large characteristic of a young child with Autism is a lack of social interactions. When a typically developing child is a year old, they should be interested in waving “hi” and “bye” to familiar people and maybe even strangers if they have an outgoing personality. They should be making good eye contact on a regular basis, and they should be enjoy your company. A child with Autism may be very introverted, enjoying their independence and playing alone. You may notice a lack of eye contact and may even notice that when you get very close to them to try and engage them, they may become irritated and try to tell you in their own way, that you are invading their space. When you see a child with an Autism diagnosis around other children their age, you may notice that they do not seem interested in these other children, but would rather play on their own, away from them. There is social avoidance with their parents also. You may notice your child in one room playing very intently with a toy, and they are always content in doing so. You may notice a lack of interest in your child trying to show you a toy that they are playing with. For example, a one-year-old typically developing child may look at you from across the room and reach out their hand which holds a ball in it as a way of saying “look at what I have!” You may also notice, and this is also tied into expressive language, a lack of your child seeking you out, and pulling you towards, or pointing to, an object that is out of their reach that they want you to get for them. Gestures such as these are apparent in a child around the age of approximately 12 to 15 months.
Repetitive behaviors may also be a characteristic of a child with Autism. Some examples of repetitive behaviors may be a child becoming very excited over a toy that they are playing with, standing up, and jumping up and down, while flapping their arms. It may be a child looking at themselves in the mirror, getting excited, and swaying side to side or back and forth. It may be as simple as a child who is sitting on the floor while playing and tapping their fingers together repeatedly. Somewhat tied into the category of repetitive behaviors is what we call “stimming.” You may notice that your child is playing with blocks and the blocks always have to be lined up in a particular order. If you attempt to stack the blocks, your child may protest. If you are playing with a pop-up-toy, you may notice that your child pops the toys up, and then pushes them back down again, but if you try to engage them in any particular pop-up-piece, they may become upset, wanting to simply go back to popping them up and then pushing them back down again. You may notice your child playing in the sand, and you realize that each and every time you have seen them in the sand, they are bringing a handful up to eye level and then dropping it. Then they repeat this behavior, and that may be the only way you have really ever seen them playing in the sand.
With an Autistic child’s lack of social interactions in mind, you may understand how transitions may be difficult for the child with Autism, simply because they tend to be very independent. You may notice that your child seems to be greatly engaged in what they are playing with and if you attempt to transition them to another activity, say, the dinner table, or out to the car, they may protest. May even have a temper tantrum. Remember, too, that a child with Autism may have difficulty with their receptive language and may simply not understand the words “it’s time for dinner,” or “it’s time to go in the car.” Transitions can definitely be a struggle for parents.
One last characteristic that I feel is important to touch on is Sensory Integration. A child with Autism often has difficulty with their sensory system. The sensory system is an entire topic of conversation all on it’s own, but to wind the explanation down greatly, when a child has a Sensory Dysfunction, their sensory system simply does not work like yours or mine. The synapses between the brain and, say, touch, for example, don’t work correctly, and the child perceives touch differently. Most of the children that I have worked with who have had Autism have needed deep touch. You may notice that when you give a huge bear hug, your child may laugh, may even give you a bit of eye contact. One little girl that I’ve worked with gave me her best eye contact when I was “rough playing” with her. They may really enjoy to swing, may love massage, may love to bounce. You may notice your child enjoys jumping and they seem to be a bit carefree, jumping off the couch at times. When they get this impact into their bodies, it helps them to feel grounded, if you will. It is a definite need that their bodies crave. Many therapies for a child with Autism will focus on Sensory Integration, helping the child to feel this comfort, this grounding, so they can focus a bit better on the other areas of their development.
Please remember that, although these are characteristics of children with Autism, not every child with Autism will display each of these characteristics. There is actually quite a large range of abilities and severities for a young child with Autism. And please also note that if your child has any of these symptoms it does not absolutely mean that they are Autistic. If you have any concerns for your child’s development, you can easily contact their pediatrician who can refer you to a local Developmental Clinic for testing. Remember that the sooner a child is diagnosed, the sooner therapy can start. The sooner therapy starts, the better your child’s outcome will be!
