Autism Screening at 18 months and 2 years
I'm excited by the news that the American Academy of Pediatricians is recommending that all children be screened at their regular 18 month and 24 month checkups for autism.
As regular readers will know, my son was diagnosed with Asperger's Syndrome, at age five, having been in a special education programme (but without a specific diagnosis) since the age of three. Thanks to the various efforts of therapists with specialities in speech, occupational and physical therapy, social development and other skills, for the most part, you wouldn't think he's any different from any other child.
The last kid in his neighbourhood to ride a bicycle without training wheels at age 7, he now rides a unicycle. There are many other examples where he has proven not only to be capable of those things that he needed help to learn, but also that he can excel.
All this because of interventions applied as early as we could get them, sometimes requiring us to fund expensive therapy ourselves, because our health insurance company states without a hint of irony that the brain does not develop past the age of seven. My thought is that this policy was drafted by someone who dropped out of school at that age, and it's certainly out of line with current neurological science, particularly the theory of brain plasticity.
"Early intervention" is a strong rallying cry among supporters of autistic children - but it is equally important to recognise that there is no age beyond which an autistic person cannot be helped - and no age beyond which autism is "grown out of"
I should note that I'm not an official source of information, and I'm only going off what I have noticed when interacting with autistic spectrum (AS) and neurotypical (NT) children. Here are some of the signs I think you should watch for in your own children:
- Pointing - does your child point to show you stuff? [Pointing to something that he wants you to get is common, even among AS kids, but pointing to show you something cool, that's something NT kids do.]
- Speech - is your child late to speech-related milestones? Babbling, single words, simple sentences - these all come in a logical progression for NT kids, but for AS kids, they may come late, steps may be skipped, or there may be a regression. An AS child may have a couple of words early on, then stop speaking altogether, later speaking full sentences without first building simple sentences.
- Social play - does your child play with other kids, or just play near them? In the park, an AS child will play on the same swings and roundabouts as everyone else, but will interact less with the children on those toys.
- Wheels - AS children are typically interested in wheels and spinning things of all types. [A story goes that Albert Einstein saw his sister when she was first born, and said "It's all very well, but where are its wheels?"]
- Physics Experiments - Kids with AS generally have an interest in finding out how things work, whereas NT kids are likely to be more interested in learning how people interact.
- Obsessive behaviour - one classically autistic behaviour in children is to line up toys - straight lines, often ordered by some characteristic - colour, size, number of wheels, etc.
- Lack of imaginative play - this doesn't mean that AS kids don't invent or imagine with their play, but by and large, a toy car will always be a toy car, and not a duck or a boat or an airplane. Pick up a toy car and pretend it's an airplane, and an autistic child may very well express irritation at your stupidity in thinking it's not a car. Similarly, even a child with little or no expression of language will get irritated if you point to a page in a book and say "this is a cow". It's not a cow, after all, it's a _picture_ of a cow.
- Lack of balance, clumsiness - particularly when an autistic child is distracted, there may be an inability to tell where the body and its various parts are. This is known as "proprioception". In combination with typically low muscle tone, this can leave the distinct impression that the AS child is more clumsy than his peers.
- One or more parent has at one time or another been described as "engineer", "mathematician" or "scientist". Seriously, in many support groups I've predominantly met parents who match this description.
- Inflexibility - when you say "we're going in five minutes", if your child throws a tantrum because five minutes have gone by, and you're not quite ready, or if you can't go to the park today because it's raining, or the cable is out and they can't watch their favourite television show.
- Transition trouble - do problem behaviours mount when you move from one task to another? Does your child get inconsolably distraught when a movie or playtime is over?
- Shutdown on overload - does your child appear completely non-responsive at times? At one time, we wanted to test Colin's hearing, because he wouldn't respond to his own name shouted from across the room. Other times, it was clear that his hearing was super-sensitive, as he would respond to his name whispered from across the house.
Make sure to compare your child with other children his own age, and watch for the milestones that you'll find listed everywhere in the parenting books. I've met autistic children with only a handful of the above signs, and some NT children who had several - but as a rough and ready guideline, I hope you'll find this set useful.
Above all, listen to your gut. Your pediatrician is an expert on kids on average and in general - you are an expert in your child, and you know far more on that subject than any pediatrician. If your child's behaviour shows a significant departure from those of other kids his age, push for an explanation. If you still have concerns and your pediatrician appears simply to be calming your fears, insist that your child be tested; visit another pediatrician if you must, get a second opinion, and keep trying to explain and accept, but work with, your child's differences.