As your baby grows, it's easy to share in the excitement of new behavior, language and skills, hoping that each area progresses as expected. In autism, the primary problem areas are language, social and emotional connections and repetitive or restrictive behaviors. Problems in these areas are usually seen by the time the child turns 2 years old, but there are challenges in diagnosing autism in a 2-year-old. These symptoms can vary widely in autistic children, and children developing normally may show similar symptoms, although in shorter, less-intense ways. The key to diagnosing autism is the presence of the combination of symptoms, which are relatively severe and which persist over time and in different locations.
One of the most striking features of children with autism is their lack of typical emotional and social connections. A child with autism may not recognize other people’s feelings or facial expressions or may try to communicate with their own expressions. Young children with autism often lack eye contact and don’t engage in make-believe play or show interest in playing with other children. Some lack an emotional human connection and treat people in the same way they treat a nonliving item, without recognizing that a person is different. Even by the time a child is 2 years old, the absence of these connections is usually readily apparent.
When a child celebrates her first birthday, she is usually starting to say “mama” and “dada.” In the next 12 months, she gains language rapidly, so that by her second birthday, she has at least 50 words. This is a period when children with autism are often identified because of their lack of language development. Many children with autism have no speech and do not try to find another way to communicate such as pointing or using gestures. When children with autism do develop language, it is usually abnormal and may be only repetitive sounds that don’t effectively communicate meaning.
Repetitive Behaviors and Restricted Interests
The diagnosis of autism includes restricted and repetitive behaviors and interests, as described in the February 2014 issue of the “Journal of the American Academy of Child and Adolescent Psychiatry.” While it is common for young children to develop a temporary deep fascination in a topic -- often trains, princesses or bulldozers -- the difference in autism is the intensity of the interest, that it doesn’t shift to other topics over time and that the focus is abnormal, such as spending hours watching the wheels of the train spin. Additionally, some children with autism will show repetitive, purposeless movements like hand flapping, body rocking or flipping a toy over and over.
Guidance for Parents
Diagnosing autism can be hard, but parents know when something seems just not right with their child, even if they may not know if it is autism or another diagnosis. If you notice your child is not showing any signs of speech or not making eye contact, talk to your child's doctor immediately. Your child may not have autism, but it is crucial to determine the cause of any developmental problems as soon as possible, so appropriate treatment can be started to maximize your child's potential.
- World Health Organization: The ICD-10 Classification of Mental and Behavioural Disorders.
- Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: Autism Spectrum Disorder; American Psychiatric Association
- Journal of the American Academy of Child and Adolescent Psychiatry: Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder
- Journal of Autism and Developmental Disorders: Subcategories of Restricted and Repetitive Behaviors in Children With Autism Spectrum Disorders
- Autism Research: Repetitive Behavior and Restricted Interests in Young Children With Autism: Comparisons With Controls and Stability Over Two Years