Red Flags/Early Identification/Developmental Milestones

Watch for the Red Flags of Autism

(The following red flags may indicate a child is at risk for atypical development, and is in need of an immediate evaluation.)

In clinical terms, there are a few “absolute indicators,” often referred to as “red flags,” that indicate that a child should be evaluated. For a parent, these are the “red flags” that your child should be screened to ensure that he/she is on the right developmental path. If your baby shows any of these signs, please ask your pediatrician or family practitioner for an immediate evaluation:

• No big smiles or other warm, joyful expressions by six months or thereafter

• No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter

• No babbling by 12 months

• No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months

• No words by 16 months

• No two-word meaningful phrases (without imitating or repeating) by 24 months

• Any loss of speech or babbling or social skills at any age

Why Early Identification

About 17 percent of children under the age of 18 are affected by a developmental, behavioral, or learning disability.1 Autism is the second most common serious developmental disorder after mental retardation.2 According to the Centers for Disease Control, the incidence rate for autism spectrum disorders may be as high as one in 166.3

With proper intervention, a child can overcome a wide range of developmental, behavioral, and learning problems. Intensive, well designed and timely intervention can improve the prospects—and the quality of life—for many children who are considered at risk for cognitive, social, or emotional impairment. In some cases, effective intervention can improve conditions once thought to be virtually untreatable, such as autism. Well-implemented programs can brighten a child’s future and the impact a developmental disorder has on the family. It can lead a child to greater independence, enable that child to be included in his/her community, and offer him/her a more productive and fulfilling life.

Unfortunately, many physicians fail to identify a developmental delay at an age when the child should be receiving early intervention services. Birth to three is a critical time in a child’s development, so a delayed diagnosis may compromise his/her chances for success.

The high (and growing⁵) incidence of developmental disabilities demands greater awareness and improved early identification. Too few physicians refer young children to early intervention, primarily, because (1) physicians may not know what critical signs to look for in a child during each stage; (2) physicians may not be familiar with early intervention; (3) insurance companies allow physicians limited time for office visits; and (4) some pediatricians believe a child’s severe developmental disability will not be affected by early intervention, while others would rather not alarm the parents unnecessarily in case the child is able to overcome the developmental delay.

Developmental Milestones

Key Social, Emotional, and Communication Milestones for Your Baby's Healthy Development

Milestones enable parents and physicians to monitor a baby's learning, behavior, and development. While each child develops differently, some differences may indicate a slight delay and others may be a cause for greater concern. The following milestones provide important guidelines for tracking healthy development from four months to three years of age.

Before your child's next visit to the physician, please take the time to see if your child has met his/her key milestones. These milestones should not be used in place of a screening, but should be used as discussion points between parents and physicians at each well visit. If a child does not have the skills listed---or if there is a loss of any skill at any age---be sure to let your physician know.

Does Your Baby…

At 4 Months:

• Follow and react to bright colors, movement, and objects?

• Turn toward sounds?

• Show interest in watching people's faces?

• Smile back when you smile?

At 6 Months:

• Relate to you with real joy?

• Smile often while playing with you?

• Coo or babble when happy?

• Cry when unhappy?

At 9 Months:

• Smile and laugh while looking at you?

• Exchange back-and-forth smiles, loving faces, and other expressions with you?

• Exchange back-and-forth sounds with you?

• Exchange back-and-forth gestures with you, such as giving, taking, and reaching?

At 12 Months:

• Use a few gestures, one after another, to get needs met, like giving, showing, reaching, waving, and pointing?

• Play peek-a-boo, patty cake, or other social games?

• Make sounds, like “ma,” “ba,” “na,” “da,” and “ga”?

• Turn to the person speaking when his/her name is called?

At 15 Months:

• Exchange with you many back-and-forth smiles, sounds, and gestures in a row?

• Use pointing or other “showing” gestures to draw attention to something of interest?

• Use different sounds to get needs met and draw attention to something of interest?

• Use and understand at least three words, such as “mama,” “dada,” “bottle,” or “bye-bye”?

At 18 Months:

• Use lots of gestures with words to get needs met, like pointing or taking you by the hand and saying, “want juice”?

• Use at least four different consonants in babbling or words, such as m, n, p, b, t, and d?

• Use and understand at least 10 words?

• Show that he or she knows the names of familiar people or body parts by pointing to or looking at them when they are named?

• Do simple pretend play, like feeding a doll or stuffed animal, and attracting your attention by looking up at you?

At 24 Months:

• Do pretend play with you with more than one action, like feeding the doll and then putting the doll to sleep?

• Use and understand at least 50 words?

• Use at least two words together (without imitating or repeating) and in a way that makes sense, like “want juice”?

• Enjoy being next to children of the same age and show interest in playing with them, perhaps giving a toy to another child?

• Look for familiar objects out of sight when asked?

At 36 Months:

• Enjoy pretending to play different characters with you or talking "for" dolls or action figures?

• Enjoy playing with children of the same age, perhaps showing and telling another child about a favorite toy?

• Use thoughts and actions together in speech and in play in a way that makes sense, like “sleepy, go take nap” and “baby hungry, feed bottle”?

• Answer “what,” “where,” and “who” questions easily?

• Talk about interests and feelings about the past and the future?

What is Autism/Common Signs

What is Autism

Autism (sometimes called “classical autism”) is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs). Autism is characterized by impaired social interaction, problems with verbal and nonverbal communication, and unusual, repetitive, or severely limited activities and interests. Other ASDs include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Experts estimate that three to six children out of every 1,000 will have autism. Males are four times more likely to have autism than females.

It is a complex neurobiological disorder that impairs a person's ability to communicate and develop social relationships, and is often accompanied by extreme behavioral challenges. Autism spectrum disorders are diagnosed in one in 166 children.The diagnosis of autism has increased tenfold in the last decade. The Centers for Disease Control and Prevention have called autism a national public health crisis whose cause and cure remain unknown.

Research now suggests that children as young as 1 year old can show signs of autism. The most important thing you can do as a parent or caregiver is to learn the early signs of autism and understand the typical developmental milestones your child should be reaching at different ages. Please look over the following list. If you have any concerns about your child's development, don't wait. Speak to your doctor about screening your child for autism. While validated screening for autism starts only as young as 16 months, the best bet for younger children is to have their development screened at every well visit with a highly validated developmental screening tool. If your child does have autism, early intervention may be his or her best hope.

What are some common signs of autism?

There are three distinctive behaviors that characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling.

The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.

Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behavior. They lack empathy.

Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.” Children with autism don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged.

Children with autism appear to have a higher than normal risk for certain co-existing conditions, including fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. For reasons that are still unclear, about 20 to 30 percent of children with autism develop epilepsy by the time they reach adulthood. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism.