Parents who notice signs that could indicate their child is on the autism spectrum should not hesitate to raise their concerns with their child’s pediatrician, two UCLA Health experts say. Alice Kuo, MD, PhD, chief of medicine-pediatrics at the David Geffen School of Medicine at UCLA and director of the University of California Leadership Education in Neurodevelopmental Disabilities (UC-LEND) program, and Rolanda Gott, MD, a developmental-behavioral pediatrician and clinical medical director of the UCLA Developmental-Behavioral Pediatrics Program, spoke with Vital Signs about what to look for and what can be done to help children found to be on the spectrum.
Why is it important to bring up any concerns that a child might be on the autism spectrum as soon as the warning signs appear?
Dr. Kuo: Early identification of autism is crucial because research studies have shown that it improves functional outcomes. If a parent has a concern about a child’s development, he or she should bring it up with the pediatrician right away. The pediatrician may decide to monitor the child’s development more closely or make a referral to a therapist for an evaluation or treatment. If a pediatrician dismisses a parent’s concern or says that the child “will grow out of it” without monitoring more closely, the parent may want to check with a developmental specialist.
At what point in the child’s development might these concerns present themselves? What should parents look for?
Dr. Gott: There are certain red flags parents should raise with the pediatrician as early as the child’s first year. If by six months the parent is smiling at the child and he or she doesn’t smile back, that’s a concern. By 10 months, when the parent points at something in the room and asks the child to look at it, the child should follow the parent’s eyes. By 7 months the child should turn when his or her name is called, and by 14 months the child should point at things that are of interest. Any sign of significant language delay is a concern. Other concerning signs would include an absence of babbling by 12 months and the child not saying spontaneous, meaningful words by 16 months. At any age, parents also should bring up any language or social concerns or regression that they notice. Parents should also bring up any language or social regression that they notice between the ages of 1 and 2. Also, if an older sibling has already been diagnosed with autism, that in itself is cause for close monitoring.
How early can autism be diagnosed?
Dr. Kuo: Researchers say that diagnoses of autism spectrum disorder are not stable before the child is 3, but a clinician experienced in caring for children with autism often can pick up on warning signs in the child’s second year of life. Language delay at 15- or 18-months is a common presenting symptom, and if the language delay is accompanied by behavioral challenges, restrictive interests or repetitive actions, then an autism diagnosis should be considered. Other symptoms can include difficulty with transitions, sensory issues (either sensory-adverse or sensory-seeking), unusual hand movements, such as flapping, and not looking at faces or making eye contact.
Dr. Gott: Pediatricians should screen all children for developmental delays — typically at 9, 12, 18 and 24 months. The American Academy of Pediatrics recommends that children receive autism-specific screening at 18 months and repeat it at 24-to-30 months. If that screening suggests the potential for an autism diagnosis, or if a clinician or therapist or educator are concerned, the child should be referred to an expert that ideally should include a physician or a psychologist specialized in autism. In California, regional centers under the state’s Department of Developmental Services can also evaluate and provide support for children with autism and other developmental disabilities.
What types of therapies are recommended for children who are diagnosed on the autism spectrum?
Dr. Kuo: As the word “spectrum” in autism spectrum disorder implies, autism covers a constellation of features, so the best approach really depends on the child. The two major research-supported approaches to intervening are speech and language therapy and behavioral therapy. UCLA has pioneered the major evidence-based behavioral treatment for children with autism spectrum disorder, known as applied behavioral analysis, which aims to increase helpful behaviors and decrease those that are harmful or affect learning. Depending on the child, other approaches can be helpful as well, including occupational therapy, therapy for sensory sensitivity and social skills groups.
How effective are these therapies?
Dr. Gott: Increasingly, autism is considered a learning disorder, so when we intervene, especially in young children, we can actually re-create connections in the brain to nurture better language and social communication, as well as improved behavior. Early intervention is crucial as it will help the child reach his or her highest potential.
Dr. Kuo: The needs of each child and their family are unique, so a therapeutic plan may include behavioral therapy, speech/language therapy, occupational/physical therapy, social skills classes and more. Pediatricians can and should help families navigate Regional Centers, the special education system in schools, therapies funded by their health insurance, and social programs like Supplemental Security Income (SSI) and In-Home Support Services (IHSS). The bottom line is to provide these children with whatever help they need to succeed in school and socially, so that they can lead productive and happy adult lives.