Warning signs of autism spectrum disorder

Early detection allows for the assessment of a child at high risk of developing ASD and the initiation of the most appropriate interventions to address their difficulties. To ensure this detection occurs as early as possible, it is essential that professionals are aware of the warning signs.

Warning signs according to age

Children with ASD exhibit a qualitative impairment in the acquisition of certain specific skills. Therefore, it is essential to assess their socio-communicative development.

6 months

• They use less eye contact.
• They pay more attention to objects than to people (visual and auditory).
• Absence of social smiling in exchanges with the caregiver.

9 months (in addition to any of the above items)

• They do not follow a familiar object with their eyes when the caregiver points to it.
• There are no relational exchanges with the caregiver (sounds, gestures, "peek-a-boo game", the baby does not respond to the caregiver).
• They do not extend their arms prematurely when someone picks them up.

12 months ( in addition to any of the above items)

• They don't babble.
• They do not imitate gestures (such as waving goodbye, clapping).
• They do not point to get an object out of reach or show objects to get the caregiver's attention, nor do they make eye contact.
• They exhibit strange movement patterns (stereotypies), and engage in solitary activities (hand or finger games in front of the eyes, rocking).
• Sometimes they seem not to feel, or they are hypersensitive to certain sounds.
• They present motor characteristics (hypotonia/hypertonia, hypoactivity/excitation).

15 months (in addition to the items above)

• They do not make eye contact when they talk to someone or when someone talks to them.
• They do not show shared attention (sharing interest in an object, activity, or other people).
• They do not respond consistently to their name.
• They do not respond to simple commands.
• They don't say "dad" and "mom" meaningfully.
• They do not say other words with propositional value (16 months).
• They exhibit particularities in the development of the reaction to unknown people (delayed or atypical: absent or poor reactions in situations of separation or reunion).

18 months (in addition to the items above)

• They do not say a single word with a propositional value (16 months).
• They don't know how to play symbolic games with toys (feeding dolls, talking on the phone).
• Lack of imaginative play.
• They do not respond when the observer points to an object (looking, verbalizing, sharing the pleasure).
• They do not point to objects, verbalize, or establish eye contact alternately between the object and the caregiver with the sole intention of directing the adult's attention to the object (protodeclarative action).
• They do not bring objects to adults to show them.

24 months (in addition to the items above)

• They do not make two-element sentences (non-echolalic).
• They show no interest in the other children.
• They exhibit a peculiar gait and/or motor skills (walking on tiptoes, turning).
• They exhibit self-harming behaviors (biting themselves, hitting themselves).
• They throw tantrums very frequently and resist environmental changes.
• They are very hyperactive, rebellious, irritable, and difficult to console.
• They prefer to play alone in a self-sufficient manner and are very independent.

From 36 months onwards

Since detection is later, it is advisable to be alert to the presence of alterations in the following areas:

Communication and language:

• Comprehension and communicative aspects affected to varying degrees.
• Poor nonverbal communication.
• Poor or non-existent response to your name.
• Slang with no communicative value. Immediate/delayed echolalia.
• Impoverished, ungrammatical, and sparse language. Pronominal inversion (the child refers to himself as "you, he, or she," speaks in the third person).
• Fluent language: literal, repetitive, dwelling on certain topics. Prosodic alteration (inappropriate melody, monotonous intonation).
• Regression or loss.

Social relationships:

• Limited edition.
• Lack of reciprocity.
• They're in their own world, they don't listen, they do their own thing.
• Lack of recognition or response of happiness or sadness from other people.
• Tendency towards loneliness, lack of social skills, lack of interest in other children and in participating in games.

Game:

• Absence or lack of imaginative play (they may make small deferred imitations).
• The symbolic content of the game is replaced by their personal characteristics, referring to a concrete register without representative content (they line up or classify the toys in some way, but do not use them for representation).
• Games or activities that attract attention because they are very repetitive, persistent, stereotypical, even obsessive.
• Unusual fixation on certain objects/toys, which they spin.

Repetitive and restricted patterns of behavior and interests:

• Fascination with some of the physical characteristics of objects.
• Resistance to changes in routines.
• Stereotypies (manual movements, rocking, spinning around, walking around the same space repeatedly, opening and closing doors).
• Sensory alterations (low tolerance to certain sounds, smells, tastes that affect life habits such as eating, clothing).
• Ritualistic behavior that closely resembles the behavior of obsessive-compulsive disorder.

Warning signs from 4-5 years of age:

Some children do not clearly exhibit signs of autism spectrum disorder (ASD) until they encounter more complex social demands. The following indicators can alert teachers and other education and health professionals to the possibility of this type of disorder.

Communication and language:

• Language impairment. Inappropriate melody, monotonous intonation.
• Unusual vocabulary for the chronological age or restricted to a topic of interest.
• Little spontaneous language or little reciprocity in conversation.
• Echolalia (delayed repetition of phrases or words).
• Limited interpretation of nonverbal language.

Social relationships:

• Difficulty or little interest in playing with other children.
• Inappropriate approaches to playing together (may manifest as aggression, obsessive interest in a game, disruptive behaviors).
• Anxiety or discomfort in situations involving changes in routines.
• Difficulties in interpreting the implicit rules of the game.
• Literal interpretation of double meanings or jokes.
• Limited eye contact.
• They show extreme reactions to the invasion of their personal or mental space (intense resistance when pressured with slogans different from their focus of interest).
• Difficulty understanding the different registers of emotional expression.

Behavior, interests, and activities:

• Disproportionate reactions to small changes (rigidity).
• Lack of flexibility and cooperative imaginative play, although they can only create certain imaginary scenarios (copied from videos or cartoons).
• A solitary, repetitive game with the same sequence.

Other areas: Unusual profile of skills and cognitive deficits (they may have good visual memory, vocabulary above their chronological age, or difficulties in abstract reasoning). Sensory hypersensitivity (anxiety in response to noise, clothing, etc.).

Warning signs in adolescence

In adolescents not previously diagnosed, in secondary and/or high school education, the following characteristics should be taken into account in addition to the above:

In social relationships:

• Limited social skills to understand behaviors related to emerging sexuality.
• Difficulties or little interest in vocational guidance.
• Vocational guidance restricted to their interests and not very compatible with a professional activity.
• Never having had close friendships and not sharing the interests of boys and girls of their age (affection, social activities, image).
• Excessive interest in a topic or activity to the point that they exhibit a surprising lack of curiosity about other activities.
• Lack of social understanding of the needs related to their age and their future.
• Social isolation due to lack of interest in relationships typical of their age, or because they do not fit into groups or do not understand how they work.
• Emotional comorbidities (anxiety or depressive disorders) are common at this age due to stress related to increased social and educational demands.

Source: Pla director of mental health and addictions. Comprehensive care plan for people with autism spectrum disorder (ASD).