Autism: What are the Initial Signs of Autism in Young Children?

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Guest: Dr. Jane M. Charles - Pediatric Genetics & Development

Host: Dr. Linda Austin – Psychiatrist

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Jane Charles, who is a Developmental-Behavioral Pediatrician. In other words, she is in an expert on developmental difficulties of children in autism in particular. Dr. Charles, what are some of the first things a parent notices in a baby when there are developmental problems?

Dr. Jane M. Charles: Specifically, for autism, a parent may notice that the child is not speaking or has delays in speech or they may have actually started speaking on time, but around 15 to 18 or 20 months of age, they seem to stop speaking and they seem to withdraw and become very quiet. There are actually more things that you can look forward that we are trying to teach parents some very earlier signs and symptoms that parents may not be aware off, that can actually show up before 12 months of age.

Dr. Linda Austin: And what are some of those signs?

Dr. Jane M. Charles: Some of those signs are, in particular, the child will not respond to their name when being called or will not even when you walk into a room and the child, the infant, or 12 month old is in the room and the parents start to speak, the child will not turn to look at the parent to see if the parent is speaking to him. We also know that before 12 months, children begin to use gestures, waving, reaching, and pointing towards things that they want and children with autism frequently will not develop gesture language or nonverbal language. They will not use gestures to point or to indicate things that they want nor will they -- before 12 months, a child also will share things that are interesting to them with the parent or share things that are fun by looking at, gazing at the parent, and then gazing down at perhaps a new toy that they have and then gazing back to the parent to say see, look, I have got something fun and something new here and this is all before a child learns how to speak. So, even though the first thing that parents notice, which might be around 15 or 18 months is that the child is not speaking, there are many signs and symptoms that show up earlier and we are trying to teach parents now what those signs are.

Dr. Linda Austin: So, in another word, it’s not just failure of language, but failure of emotional interaction that most parents start to see picking back six months or eight months, a child will reach out to be picked up for this level.

Dr. Jane M. Charles: Exactly.

Dr. Linda Austin: And those kinds of behaviors are diminished or absent?

Dr. Jane M. Charles: Yes, they may be absent. Yes. About 25% of children with autism spectrum disorders actually develop normal social interaction and language until around 18 months when they have this episode of regression and nobody is sure why children with autism regress this particular 25%. The rest of the children with autism actually do not -- just never develop social interaction or never develop language.

Dr. Linda Austin: There must be other causes besides autism of some of those changes or some of those differences that you see in babies?

Dr. Jane M. Charles: Well, actually there are no other reasons to have social withdrawal or lack of social development in a child. Autism is about the only diagnosis that you can have for that whereas with language delays, you can have just a language delay, which is not uncommon at all; especially just an expressive language delay, which is the language that comes out of your mouth. Another reason for language delay would be metal retardation. About 2% of the population in South Carolina has mental retardation. So, it’s something, we would test for as well. If a child came in and then chief complaint were lack of language, then we would evaluate for several different things. One would be mental retardation, one would be just a simple language delay, one would be autism, it would be another reason. We would also check to see and make sure that the child could hear because if you can’t hear, then you are not going to learn how to talk. So, that’s a very simple test of course to get a hearing test and make sure the child is hearing. So, these are some of those things that we would evaluate a child for if they came in with the main concern of delay in language.

Dr. Linda Austin: If a parent begins to be concerned, let’s say at 8 months a parent begins to notice that their child -- says the second child is just not as engaged and interactive as the first child was for example, how long would you suggest they just observe before bringing the child in for some kind of evaluation?

Dr. Jane M. Charles: I would say not to wait at all. Unfortunately, it ends up being a watching and waiting type of situation because we do not have any diagnostic tools that can evaluate a child for autism below about the age of 15 months, but if it’s a situation especially where the first child in the family already has autism, diagnosis of autism then we would want to follow the second child and all the other siblings too and watch them to make sure that they are not evolving and developing an autism spectrum disorder. So, we can go ahead and start some things when the child is 8 or 9 months if they don’t look to be very engaged. One, we can get a hearing test to make sure they are hearing and rule out all the other reasons why a child may not be engage or may have a language delay. Then, we would probably place them at risk for having an autism spectrum disorder and we can just go ahead and start for example speech therapy and start trying to engage them with specific social types of therapies and then when the child becomes old enough for us to do an actual diagnostic test, then we can proceed. Fortunately, there are all around the country, several researchers are developing tools to trying to reach down to diagnose kids at 12 months, but then that doesn’t catch the group of kids that the 25% that developed normally and then around 18 months then they have this pre-period of regression, so it will miss those kids. But we are trying to teach the pediatricians through the American Academy of Pediatrics. There is a big push to raise awareness among pediatricians to begin developmental screening very early and now that we know that autism is not an uncommon disorder that it occurs in one in 150 people that they need to have high awareness and that this can evolve and that they should question parents about their child’s social skills.

Dr. Linda Austin: There are surely many regions here in South Carolina and in other sates where there are not developmental pediatricians like you. Would you suggest that any parent take the time, make the trip to have their child evaluated for autism if it looks as if there is a serious concern or do you think that typical pediatrician or family practice doctors equipped to be well enough informed to be helpful?

Dr. Jane M. Charles: The first thing the parent should do that they should report to their physician and ask for a developmental screening type of evaluation and then either the parent or the physician should make a call to the early intervention program in South Carolina, which is called BabyNet and they follow children 0 to 3 years of age and the BabyNet counselors are equipped to do developmental screening for all developmental disabilities including autism spectrum disorders. Again though, the only tool we have right now goes down to about 15 months, but if the child can go ahead and get in the system and start the process of developmental screening and then while waiting to be old enough to have an evaluation.

Dr. Linda Austin: How does one excess BabyNet?

Dr. Jane M. Charles: Probably, the best way would be to call your County Health Department and ask how to contact the County BabyNet Department.

Dr. Linda Austin: Or perhaps alternatively Google BabyNet.

Dr. Jane M. Charles: You could Google BabyNet in South Carolina. Hopefully, your pediatrician or family medicine physician would also have the number for BabyNet at their office.

Dr. Linda Austin: We will be talking in another Podcast about the treatment options for these children. Thank you so much

Dr. Charles.Dr. Jane M. Charles: Thank you.

Announcer: If you have any questions about the services or programs offered at the Medical University in South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at 1-843-792-1414.

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