The main symptoms of a child with suspected autism are poor or limited with social interaction, poor communication, repetitive behaviours such as rotating himself/herself or rotating objects. Restricted interests such as playing with same toys in a same way repeatedly are also a key feature in autism. Common types of restricted interests include rotating or watching wheels of car, banging objects, playing with water tap repeatedly, opening and closing of doors repeatedly. Note these behaviors are considered normal by most parents and neglected. If you feel that you have any of these symptoms of autism, you need to contact specialist such as a paediatric neurologist, developmental paediatrician, paediatrician expert in development neurology or a child psychologist who can do behavioural evaluations. The key to early treatment of speech delay and autism treatment is to act early

Speech delay alone is not worrisome, but early intervention causes no harm. The intervention or therapy needed in such a scenario includes behaviour medication and speech stimulation.

Causes of speech delay today and decade back are different. The electronic median like YouTube, mobile, TV were not available decade back. Parents were not working and only spent time with family. Speech delay along with poor eye contact, poor social interaction and repeated behaviour should prompt for early consultation with a specialist for evaluation of speech delay, autism and other behaviour disorders. Clinical experience suggests that therapy modality like early intensive behavioural intervention, is useful in improving language and behaviour in individuals with autism.

In simple words, autism should be suspected if child has

Poor social communication and poor or no interaction with other children and family members

Repetitive behaviours, repetitive interests, or repetitive activities

Symptoms that limit and impair daily functioning

One must suspect Autism when there is lack of:

Response to own name by 8 months- rule out hearing disorder or neurological disorder

Babbling by 12 months- rule out hearing disorder or neurological disorder

Gesturing (pointing, waving bye-bye) by 12 months- rule out vision, hearing disorder or neurological disorder

Lack of Single words by 16 months- rule out hearing disorder. If physical or motor milestones are also delayed, rule out a neurological disorder

Lack of Two-word phrases by 24 months

Loss of any language or social skills at any age- rule out a neurological disorder

Delayed social smile

Poor or minimal eye-to-eye contact, poor facial expressions, abnormal body postures and gestures

Poor social interaction with other children and family members

Minimal or no sharing of enjoyment and interests with other people

Most important in children with autism is that the child interacts only when he wants something. Otherwise, most of the time, child is indifferent to parents and other members

Social communication and interaction can be difficult in children with autism

Examples of poor social communication and poor social interaction in autism include

Child avoids or does not keep eye contact

Child doesn’t respond to name by 9 months of age

Child doesn’t show facial expressions like happy, sad, angry, and surprised by 9 months of age

Child doesn’t play simple interactive games like pat-a-cake by 12 months of age

Child doesn’t wave goodbye by 12 months of age

Child doesn’t share interests with others

Child doesn’t show you an object that he or she likes by 15 months of age

Child doesn’t point by 18 months of age

Child doesn’t look at what you pointing by 18 months of age

Child doesn’t notice when others are sad by 24 months of age

Child doesn’t interest in peers

Child has trouble understanding other people’s feelings

Child cannot talk about own feelings at 36 months of age

Child doesn’t play games with turn taking by 60 months of age

• Body rocking, hand flapping, spinning, rotation and tiptoe walking
• Fascination with certain numbers, letters, sequences of cars, arranging sequences of utensils in a line, sequences of alphabets in a line, ritualistic and repetitive schedule, attachment to certain objects, especially parts of a toy, like cars, switches, doors, revolving chairs
• Fixed adherence to routines or rituals like handwashing
• Always playing with water
• Repetitive door opening and closing
• Repetitive playing with light switches
• Repetitive opening and closing of door
• Banging of objects like toys, utensils
• Climbing up and down again and again

Lines up toys or other objects and gets upset when order is changed

Lines up cars, alphabets, utensils, colours and gets upset when order is changed

Repeats words or phrases over and over

Plays with toys the same way every time like cars, buttons, blocks

Is focused on parts of objects (wheels of car, hinges of door, revolving chair)

Has selective interests with same toys again and again

Child flaps hands, rocks body, or spins self in circles, rotates in circles,

Likes playing with mud, water, wash basin again and again

Likes banging of objects repeatedly

Repeated play with cars like lining of cars in line, watching the cars wheel

1. Visual: Seeing things from a particular posture or angles
2. Auditory: pretends to be nonresponsive to sounds, clapping hand over their ears, hearing close to objects
3. Olfactory: Sniffing objects, foods
4. Touch/taste: Refusing to eat food certain tastes or certain foods, mouthing of objects, compulsive touching of certain objects or textures, less response to pain, attachment to touch like tap water, or reluctance to bath
5. Behaviour inappropriate to circumstances
6. Excessive crying or laughing

Please notice and add these points in the register which you have to make. These problems are quite common

• Responds negatively to loud noises like tractor, cooker, door bell
• Holds hands on ears to avoid sounds
• Gets distracted with sounds and doesnt do the word
• Enjoys making strange noises with different objects like banging, throwing, hitiing, breaking
•  

Please notice and add these points in the register which you have to make. These problems are quite common

• Prefers darkness
• Gets irritated with bright lights
• Difficulty in playing puzzles
• Looks carefully at certain objects like fans, cars, rotating objects, doors, revolving chairs

Please notice and add these points in the register which you have to make. These problems are quite common

• becomes anxious when foot is off the ground
• Avoid moving plays like swing, see-saw
• Excessively attached with motion play like swing, rocking horse, revolving chairs
• Likes climbing up and down the furniture
• Self Spinning or self rotating
• Rocking movement while playing

Please notice and add these points in the register which you have to make. These problems are quite common

• Likes making things dirty like sand, atta, colours,
• Doesnt like hair cutting, hair trimming,  brushing, bathing,
• Like certain textures of clothes or dislikes certain textures
• Gets irritated by shoes, socks, clothes
• Avoid walking without shoes
• Doesnt like touching
• Reacts aggressively on touching
• Avoids standing close to other people
• Rubs or cleans or licks the part of body which has been touched
• Constantly touching objects, walls, textures, 
• Decreased pain sensation on injections
• Doesnt notice when someone touches him/her
• Avoids wearing shoes
• Excessive touching
• Always like to be extra clean
• becomes anxious when foot is off the ground
• Avoid moving plays like swing, see-saw
• Excessively attached with motion play like swing, rocking horse, revolving chairs
• Likes climbing up and down the furniture
• Self Spinning or self rotating
• Rocking movement while playing

Please notice and add these points in the register which you have to make. These problems are quite common

• Doesn’t identify objects by name, or identifies very few objects like mobile (which are of his interest)
• Doesn’t identify parents by name. For eg, IF we tell the child to give the pen to mummy, he doesn’t know that who mummy is. he may go to mummy when he needs food to fulfil his needs. 
• Speaks colours (learnt from youtube), but cannot identify colours when asked
• Speaks alphabets and numbers (learnt from youtube), but cannot identify alphabets when asked. Child doesnt point or name
• Always singing rhymes or poems learnt from youtube. But doesn’t speak when asked directly. Interpreted by parents as moody
• Points body parts inconsistently. Interpreted by parents as moody
•  

1. All children with autism do not have all the symptoms and the frequency of these symptoms varies among different children. One of more symptoms may be predominant in autism
2. Even if all symptoms are not present, we aim to improve the behavior which are not good

Children with autism have good gross motor skills like running, jumping and climbing. They may have good intelligence as well like matching shapes, sorting out sizes and colours. However, children with autism have poor social AND expressive skills and restrictive interest. Their eye contact may be poor. 

Child have good

Gross motor or physical activities such as running, dancing, climbing

Fine motor activties- like open closing bottle, pen, writing

Memory- remembers roads well, identifies sound of car, remembers grocery shop, 

Good visual matching- like arranging alphabets, numbers, colours, matching, sorting

But problems in behaviors such as

1 Social behavior, adjusting to people, understanding people, playing alone

2 Emotional  problems such as crying, anger, irritable nature, hitting, biting, throwing things, breaking things

3 Unawareness- inability to understand opposite persons feelings, likings; holding strangers hands, eating from other peoples tables in restaurant, pulling things from other people

4 Understanding language-receptive language like responding to name, understanding commands and instructions, identifying object by name, question and answer

5 poor speech, vocablary

1. As you observed, your child responds to only sounds or words of his interest like mobile, water, chocolate etc. This is meaning of restrictive interests. Restrictive or reputative symptoms are one of core features of autism. When the child doesn’t respond consistently to commands of parents or name, the child is considered to be inattentive. inattentive is an early clue towards autism. All such children need hearing evaluation by BERA test, which is a hearing test

1. As discussed above, child may have normal to high intelligence. Frequently, when the child is exposed to electronic media like mobile, you-tube, television, the child becomes so absorbed in these electronic gadgets that the child stops paying attention to human voices of parents. As exposure of child to electronic media is increased, the child become inattentive and doesn’t respond to name. Inattention, poor eye contact, self-absorbed behaviour are early symptoms of autism. Mobiles are not to be introduced in any child less than three years of age. We should not boast the child’s skills of operating a mobile. Children less than three years of age need to learn social behaviour and language and not operating a mobile

1. Autism has both genetic and environmental/family environment related causes. So, it is possible that there may not be any history of autism in any of family members. However, please assess if any member of your family had hyperactivity, ADHD, intellectual disability, epilepsy, seizures, or there is any marriage between closed related cousins/family members.

Even if few symptoms or behavior are present, it is advisable to start autism treatment. Autism treatment is nothing but parent training, parent education and lifestyle modification. No medicines or injections are given in early symptoms of autism. There is minimal cost  involved in early treatment of autism. Early lifestyle changes  lead to good results in autism. There is very variable and different diagnosis given in early symptoms of autism. We suggest to act early before it is too late

• Sadly, doctors with expertise in child behaviour are few. Children with ADHD are always walking and moving around, but they respond to commands and name and may not show repetitive behaviours

Children with autism may have hyperactivity and aggressiveness. When demands, likes, needs of such children are not fulfilled, these children get angry, hyperactive and aggressive because of poor ability of expression with language.

Children with speech delay alone have good comprehension skills, normal social behaviour and no repetitive behaviours

However, the diagnosis can be made with precision by Paediatric Neurologist

What progress has been made so far in autism research?
In the past five years, scientists have made significant progress in discovering the genes that contribute to autism. With this knowledge, there has also been much progress in understanding what might be different in the cells of the brain of a person with autism. Scientists in many fields are working toward a deep understanding of the mechanisms that lead to autism. Therapy options are easily available.

Autism is entirely a clinical diagnosis based on observation of child behaviour, child play, videos of child playing and history by parents

Diagnostic Tools which may be used include

CARS (Childhood Autism Severity Scale)-severity.

ISAA

There is no test to diagnose autism spectrum disorder. The diagnosis is made based on observation of behaviour of child in play room or videos. The main characteristics for diagnosis include deficits in social communication and social interaction, and repetitive behaviours.

Certain tests like MRI brain, EEG test, hearing test like BERA test may be done in certain situations by the treating clinician. Blood tests may be done to exclude nutritional causes. The test is not to diagnose autism, but to exclude disorders which may have symptoms of autism and need separate test

What is the cause of my child’s autism?
In most situations, the exact cause of autism cause may not be identified. In most of the situations, behavioural changes in autism are caused by poor parent-child interaction, child playing alone, poor availability/ interaction with other children, misinterpretation of repeated behaviour as normal play. However, there are certain genetic disorders associated with autism such as Rett syndrome and fragile X syndrome. In approximately 25 percent of children with autism, a specific genetic cause may be found

If you are interested in genetic testing, you can ask your Paediatric neurologist or geneticist for explaining the test process. After a detailed history, your Paediatric neurologist may recommend genetic testing, which is a simple blood and urine test. These tests are specialised test and not available at routine laboratories. The reports of these testing take 1-2 months. Multiple genetic tests may be needed and each takes additional time. So, if you are planning a next pregnancy, we suggest that you get these complete evaluations before the pregnancy itself. Such tests cannot be done in pregnancy because of time constraint. The tests are not done to identify whether the gene came from which parent. Even if any of the parents has an abnormal gene, they may be unaffected throughout the lifetime. These genetic tests mainly help for planning the next pregnancy.

If you are interested in genetic testing, you can ask your Paediatric neurologist or geneticist for explaining the test process. After a detailed history, your Paediatric neurologist may recommend genetic testing, which is a simple blood and urine test. These tests are specialised test and not available at routine laboratories. The reports of these testing take 1-2 months. Multiple genetic tests may be needed and each takes additional time. So, if you are planning a next pregnancy, we suggest that you get these complete evaluations before the pregnancy itself. Such tests cannot be done in pregnancy because of time constraint. The tests are not done to identify whether the gene came from which parent. Even if any of the parents has an abnormal gene, they may be unaffected throughout the lifetime. These genetic tests mainly help for planning the next pregnancy.

children with abnormal head size (small/large)

Children with positive family history and other affected members of autism

dysmorphic Children

A lot of changes are needed in lifestyles of parents (especially in Indian context). We suggest child care leave for the mother for minimum of 3-6 months for complete care of child. In addition, mother must be relieved from all household activities like cooking, house-cleaning, etc. Maids for child care must not be involved. Mother should be involved in every activity of child like playing, dressing, bathing, and feeding. Mother is bridge for the child with the outside world. Maids and other family members can help in other household work. But the initial interaction is essentially the role of mother.

None of adults or children should watch TV/mobile while eating. Children learn behavioural skills from parents. Mother should try to interact with the child while eating. No other member should feed the child besides the mother. Autism treatment and speech therapy requires a lot of commitment

• grandmother (dadi/naani) mainly attend to food, hunger and toilet demands of the child. They will want the child to play and not disturb them. Not uncommonly, because of lack of friends, the child learns to spend time alone with toying, talking to them. Most commonly, grandmother give the child rhymes and poem on YouTube. The child would be very happy. The grandparents are happy that the child is not disturbing alone

In this process, child learns to be alone. He loses interaction with other family members. He stops being attentive to parents’ voice. And gets angry, hyperactive and aggressive if his demands are not met. This leads to vicious cycle. This misconception leads to delay in autism treatment and child learning is often slowed down. 

• Per se, treatment of autism is not medicinal. Multivitamins contains L-carnosine, omega 3 fatty acids, DHA may be used. Mood stabilisers may need to be used for children with emotional distress, aggression, hyperactivity and self-injury in autism. These medicines do not lead to improvements in social skills, language or communication in autism

• The initial goal of treatment or therapy is to improve attention and socialisation. Early interventions or therapy are focused on parent training and behavioural therapy. Such therapies alone can improve social skills, communication, language use and aggressive behaviours. Principles useful in therapy involve occupation therapy, physical therapy, behaviour therapy and psychotherapy, speech stimulation, and play therapy

Eye contact-will it be improve with other people

How will there be touch sensitivity

Vision sensitivity for change in household

Incidence of Autis spectrum disorder in boys is 1 in 42 and in girls is 1 in 189. This 1 in 68 children may have autism, which is very common

Obsessive compulsive behaviour, intellectual disability, epilepsy, behavioural problems, food choices, eating mud or wall paint, sleep variability, altered mood, and hyperactivity (ADHD) may be present in some of the children with autism (but not all). The severity and frequency vary in different children

• Difficulty going off to sleep
• Frequent awakenings
• Decrease in sleep time

• Use visuals-flash cards, posters, idols for therapy
• avoid long strings of verbal instruction- simple instruction, frequent repetitions, simple sentences
• Use printed words and pictures on a flash card.
• Encourage child’s likes
• Use child’s fixations to motivate him to do school work
• Use concrete, visual methods to teach number concepts
• Interact with the child while swinging or rotating
• Don’t ask children to look and listen at the same time
• Use tactile learning materials (sandpaper alphabet)

Children diagnosed early for autism and managed with proper guidance and therapy improve in 6-18 months. Children who present late may have some behavioural abnormalities compared to other child. More often, children with autism may also have high intelligence because of their peculiar and sharp observation skills and restrictive interests. They may interpret complicated patterns with relative ease. So, it would be too early for us to worry for the intelligence of the child

If the speech delay is neglected, child do not learn what is expected of them because of low attention. Low attention leads to low memory and low intellect. Parents who neglect early symptoms of autism, lead to low intelligence at age of 5-15 years