Autism: how to recognize the signs in the first year of life

The 2nd of April, World Autism Awareness Dayinvites professionals and families to share not only the most well-known aspects of this disorder, but also early detection that allows them to do a better job with children.

According to the World Health Organization (WHO), one in 160 children has an autism spectrum disorder or ASDbut the entity recognizes that this is an estimate nothing more, since the figures vary in the different investigations.

The campaign “A Happy Journey for Life”, organized by the Spanish Autism Confederation and Autism Europe, estimates that around 7 million people live with the disorder in Europe, and in Spain there are more than 470,000. The organization Autismo Ecuador has enabled a registration formin order to obtain real statistics of cases diagnosed with autism and Asperger’s.

“It is important that alerts are attended to on time; the early diagnosis can guide the work to have successful results in the future”, says the clinical psychologist and master in Autism and Psychoeducational Intervention María José Jáuregui (@psicologamariajosejaureguiOn Instagram).

She says that while a one-year-old cannot be diagnosed with autism, it can be detected. autistic traits. But this is not meant to alarm the family. “The diagnosis is not a label, but a guide to know how to proceed and achieve better results.”

What is autism spectrum disorder?

From the perspective of Jáuregui, who has been working in this field for 17 years, autism is a subjective stumble in the constitution of the selfwhich comes to be the awareness of oneself, of identity and of the relationship with the environment.

“That me doesn’t arm properly, and because of this, the child is not appropriate to his body”, indicates the specialist, “for example: they call him and he does not respond to the name. She doesn’t want to look at other people. Sometimes he hits himself really hard, but he doesn’t feel the body”.

Here comes the early intervention, which aims to establish that self as soon as possible, something that in a regular or neurotypical child would happen around the age of 2.

Another obstacle is the general view of autism as an irreversible disease. “We have to break with the myth of autism that we have seen in the moviesthat practically no longer exists”, considers Jáuregui, and this is due to interventions in children who come to consultation early, with communicative stumbling blocks that range from not speaking to talking only about their interests, but not being able to tell about their life.

The diagnosis (of autism) is not a label, but a guide to know how to proceed and achieve better results.

Maria Jose Jauregui

Jáuregui observes certain trends among children with communication or social difficulties. A group evolves well, says words, and between the ages of 2, 4 or 6 they have a hearing setback, they lose the communication skills they had acquired. “He said now with his little hand, and he left it. She said mom and dad, and she forgot. She said water, and she stopped asking for it. She looked into his eyes, looked when we called him, and not anymore”. And in another group, the child always had a slower development than expected and did not speak.

In socialization difficulties there are also several levels. “There are children who do not take others into account, but there are also those who are interested in others, they want to participate in the game, but they do not understand the social dynamics.”

Alerts can occur in the first years of life, hence the importance of a pediatrician being able to detect irregularities. “See if the child, at 3 months, has a social smile; if he is 2 years old and does not speak ”. And then immediately refer someone specialized in differential diagnosis, and after that choose a professional specialized in autism with whom the family feels safe.

Talk to your pediatrician if you notice that your child is having sleep and eating disturbances. If he cries despite being well cared for and fed. If at 3 months the social smile does not start. “Sometimes parents say that the baby doesn’t laugh because they are serious. It’s not about that. It is a milestone that the child has to meet. The babbling must also begin”.

Another important milestone, between 6 and 9 months, is to point out. “It is one of the first communicative gestures. In this way, one can understand what the child wants, and furthermore, he can name things, so that he acquires the language, and after a year he will already have three, four, five words”.

Another essential moment is that between 5 and 7 months the child already reacts, turns and looks when called.

Like size and weight, these reactions are a guide to development. “These processes will mean that at one year, the child will be able to use simple gestures: pointing, shaking his head when he wants to say no, saying hello or bye with his hand, calling mom and dad, asking for water, following basic instructions, such as bringing a toy if asked, look for something that is hidden, walk or stand up against furniture”.

Also note the connection the child has with the environment and with other people. The interest in showing things that he discovers, “that is called triangulation of the object, he finds a leaf, comes and shows it to me”.

The first year of life is essential for the subjective constitution, and for this reason it is not possible to wait until twelve months to begin teaching them. “The first year is the basis of the constitution of the self.”

Characteristic signs of autism: flapping wings and walking on tiptoes, not necessarily when they start to walk, but when this persists at 2 years. Refusal to wear a hat or accessory on the head and to have their hair cut. Food selectivity. Low tolerance for changes and transitions. Hold things in the hands, but without using them. Wander around the house, but little interest in playing with parents.

Fear of certain everyday noises (blenders, drills) and certain songs. “Although they are very musical, it may be that certain songs scare them.” Y auditory selectivity.

The latter is noted in the child does not respond when called by name, but if he hears the cartoon he likes, he runs to watch TV. If he is asked to do something, he doesn’t seem to have heard, but if he is asked out, he is ready because he wants to go outside.

Repetitive behaviors usually come later, Jáuregui points out, but it is possible that after a year they begin to line up with toys or other objects, when the symptoms are very marked.

What is early intervention in autism?

The therapist believes that it is very important that the child does not feel that he is sick or going to the clinic, so her work with them takes the form of a class in which she helps them to learn to speak, play, communicate and control the body. “When they ask me, I tell them: Just as other children have stumbling blocks to add, you have a little trouble talking.” This approach gives them confidence, “because it does not put them in a medical chart, as if they were sick.”

The purpose of a neuropediatric evaluation is not to label the child, but to know what therapeutic accompaniments and complementary studies are required.

Dr. Daniel Cruz Montesinos

For the intervention to be successful, several pillars must be in place. The first is a school that welcomes the child and is sensitive to his stumble. “Not necessarily that he knows about the subject, but that he has the desire to help”, opening up the team that works with the child.

In cases with very strong symptoms, it may be necessary to an integrative teacher. “She is a teacher that the team trains so that she can empower the child in all school aspects.”

The other pillar of the intervention is choosing the right therapies for each case and be constant. Work with armed groups with professional criteria, according to the level of communication and socialization.

And the last one is family-centered practice. “Everything that the child acquires must also be acquired at home, so that the quality of life of the family improves,” says Jáuregui. “family commitment it is to cure communication within the house and make the child socialize”.

Suspicion, but not definitive diagnosis

The diagnosis of ASD can be suspected before the age of 18 months, but the definitive diagnosis will only be possible between 24 and 36 months, says Dr. Daniel Cruz Montesinos, a pediatrician and pediatric neurologist. The diagnosis before this age should be made with great caution, because “diagnoses are constructed and, sometimes, deconstructed”.

What does this mean? What the diagnosis is not definitive, it cannot be rigid. We must observe the evolution of each child.

In addition, Dr. Cruz expresses that according to the Latin American Consensus (of the international method) Modified Delphi (2021), professionals are suggested to use the term ‘risk for communication and language disorders’ (RTCL) in patients between 9 and 36 months who have a delay in verbal (speech) or nonverbal (social) communication and who do not yet meet established diagnostic criteria for autism spectrum disorders (ASD), developmental language disorder (DDL), or pragmatic language disorder ( social communication disorder or BPD).

“All patients with RTCL must have an assessment by an interdisciplinary team that includes a early intervention”, establishes Dr. Cruz. “Your follow-up should be at least every three months, to assess whether you meet the diagnostic criteria for any of the aforementioned disorders and ensure that early interventions adjusted to your context are being carried out.”

The application of a specialized screening questionnaire called M-CHAT-R/F™, designed for an age range between 16 and 30 months in all children with RTCL, is also recommended. For children under 18 months of age, the test must be repeated at 18 and 24 months.

The pediatrician emphasizes that The purpose of a neuropediatric evaluation is not to label the child, but to know what therapeutic accompaniments and complementary studies are required.

Among professionals there are several positions regarding ASD. Some consider it to be an organic condition, and others not. “The question about autism and its origin is still open,” says Jáuregui, who believes that autism is not a disease, because through work with the family, with the school and communication and socialization therapies, many children are helped to stabilize and fully integrate, to the point that the initial condition is no longer noticeable.

The therapist comments that many families who are discharged by her do not see the point in continuing to talk about the subject, since it would be like keeping that diagnosis for life. “Then why are we going to keep saying she’s autistic?” she muses. “Why keep naming (the disorder), why keep identifying the person as autistic?” (F)