Recognizing Signs of Autism in Infants

Parent’s Monthly magazine interviews Dr. Asaiskar

Recognizing the symptoms of autism as early as possible is critical to a child’s outcome, says a local specialist who cares for pediatric patients.

“Most symptoms of autism occur within the first or second year of life,” says Dr. Shailesh M. Asaikar of Sacramento’s Child and Adolescent Neurology Consultants. “Yet the diagnosis is delayed until the child is ready to enter school. This disparity between the onset of symptoms and recognizing the disorder is discouraging.”

Autism is a collection of developmental aberrations with a varying severity of signs and symptoms and is therefore classified as a “spectrum disorder.” The deficits are in the areas of communication, cognition and constitution.

“Assessing deficits in infants in these areas is extremely challenging and demands a high level of knowledge, experience and intuitive skills,” Dr. Asaikar says. “It is often said that it is easier to recognize an infant with autism rather than describe one.”

He says the diagnosis of autism involves familiarity with normal and abnormal child development. The focus of deficits in autism is primarily on communication both verbal and nonverbal, play, cognition, temperament and, to a lesser degree, on sensory and motor deficits.

“It is all the more difficult to assess these areas of deficits in infancy given the limited set of milestones in the above-mentioned areas at that stage,” Dr. Asaikar says.

Parents need to be able to recognize behavior outside the normal range in communication, play, cognition and temperament in the nonverbal infant. The communication of an infant is judged by measuring his or her eye contact, his or her interest in the human face and the length of time the interest is maintained. Is there a preference for the human face over inanimate objects? Does the baby babble? And does the babbling have communicative intent as heard in the melody of the babble, which may signify joy, pleasure, hunger or anger merely from the pitch and tone of the vocalization? Does the infant provoke interaction by pointing, smiling and vocalizing? Is there a rich bank of gestures? One gesture of particular significance is pointing, which is a measure of shared attention.

“Play is a means of exploration through which a child achieves symbolic and functional representation of the environment,” Dr. Asaikar says.

“Autistic children’s play is mechanical, repetitive and hyperfocused. They often show more interest in parts of a toy rather than in the whole, as seen in children who seem to be more interested in watching the wheels of a toy car spin rather than racing the car,” he continues. “Other areas of abnormal play can be observed when a child engages in excessive ordering, sorting and categorizing rather than engaging in pretend and symbolically meaningful play. An example of this behavior is lining up of objects or sorting objects according to shape and color rather than function.”

Feeding difficulties are common in infants with autism. Parents will describe them as picky eaters. Their food choices seem to be governed by the texture rather than the taste of the food. Many of them fail to thrive and gain weight and as a consequence can be subjected to rigorous and unnecessary gastrointestinal work-ups in an effort to pinpoint the problem.

“I often explain that these children will not eat as against cannot eat. In other words, they refuse to eat rather than being physically unable to eat,” Dr. Asaikar says.

This leads directly to the temperament of autistic infants. They do not like change, he adds. They transition poorly. They can be passive, aloof and disengaged or irritable and difficult to soothe or comfort. They are frequently described as colicky and having problems going to sleep.

It is problems with motor skills that bring these children to the attention of physicians. Low muscle tone and mild delays in the acquisition of gross motor milestones is not an uncommon presentation. Movement disorders such as stereotypys (repetitive motor movement such as self-stimulation) are common. Another curious symptom is sensory aversion. These children cover their ears when subject to loud noise. Labels on the inside of garments irritate them and cause disproportionately severe anguish.

A visit to a physician, Dr. Asaikar says, will result in a structured interview, examination and assessment of development and identification of where along the spectrum the child fails. This gives parents insight into the severity of the problem and the stability of the diagnosis. The physician prescribes tests to rule out other syndromes or secondary causes of autism. The parents are given a “to do” list in order to gain early intervention from ancillary providers such as speech, behavioral or occupational therapists. The child is monitored from time to time for developmental advances. A small fraction of children may require medication for behavior, epilepsy and sleep disorders.

“Last and not least, the physician can guide and advise parents through the maze of complementary and alternative treatments, which are at times conflicting, confusing and exploitative,” Dr. Asaikar says.

For more information, contact Child and Adolescent Neurology Consultants:

1111 Exposition Blvd., Bldg. 700, Ste. 102, Sacramento, CA 95815) at 916-649-9800 or go to www.sacchildneurology.com

Reprinted with permission from Parent’s Monthly magazine, October, 2008.