Ashley Brien, Ph.D., CCC-SLP
Key Points:
Social Interaction and communication are often the first signs of Autism
It is important to remember that Autism is a combination of skills and not just one sign
The CDC has video resources that help with detecting Autism
Early Intervention is recommended if you suspect Autism
What is on this page:
CDC Autism Videos
Early Signs of Autism
Diagnosing Autism
If you’re reading this, chances are you might be wondering about your child’s development and perhaps, more specifically, if your child might be showing signs of Autism. Autism is a neurodevelopmental disorder that can often (but not always) be detected at a young age and presents as challenges with social interactions and restricted behaviors. For a more detailed description of Autism, check out Autism Spectrum Disorder.
It might be somewhat easy to imagine what challenges in social interactions look like in adults, adolescents, or even older children, but how do we know if toddlers, who might not even use verbal speech yet, are having trouble socially connecting with others? Although Autism is a heterogeneous condition, meaning no two people with an Autism diagnosis are alike, there are several features that we can be on the lookout for to help us decide if we should have our child evaluated for Autism.
CDC Autism Videos
The Centers for Disease Control and Prevention (CDC) has compiled several videos that capture some of the early signs of a potential Autism diagnosis. These videos highlight skills such as initiating and responding to joint attention, responding to name, playing with toys, using verbal language to communicate, transitioning to new activities, etc. A list of these videos can be found here and most of the videos can be found on the CDC’s YouTube page.
One video that we find particularly useful for understanding early social interaction skills compares two twin boys, about a year and a half old, engaging in the same activity with their mother. One of the twins demonstrates early signs of Autism and the other does not. Before we break down the video and compare and contrast the two boys, go ahead and watch the video here.
Neither of the two boys might have seemed particularly “social” in the ways that we tend to think about being social. Both were playing with a toy and neither seemed to say many, if any, words. But if we consider that these play interactions were guided by and included the children’s mother, and we compare how the two boys separately interacted with her, we can start to understand what social interactions might look like in toddlers.
Early Signs of Autism in Toddlers
Starting with Ben, what did you notice about his social interaction style? You probably noticed how he seems to be enjoying the play session with his mom. Not only is he pushing the train back and forth for several turns, he is also smiling! He uses lots of facial affect (a.k.a. facial expressions) to indicate that he wants to keep playing.
Early Signs of Autism
- Facial expressions of enjoyment or paying attention
- Requesting and Initiating other’s attention.
- Imitating actions and words
- Combining gestures and words at the same time.
If we look even closer, you might notice that Ben is using gestures to communicate. At the beginning of the video, Ben holds out his hand in what looks like a “pushing” gesture. At the same time, he says what sounds like “push”. He is initiating, or starting, the play session with his mom! Combining gestures and words together is a language developmental milestone that adds meaning to a word, and this milestone tends to occur around 18 months of age, right around the age that Ben and Nathan are in this video.
Another way that toddlers develop language and social connection with others is through imitating. That’s right! If your baby or toddler is copying the things that you are doing, they are imitating you and subsequently learning about the world around them. In this video, we see Ben imitating his mother on several occasions and in a number of ways. First, he imitates her actions by pushing the train back and forth multiple times (which also shows that he is playing with the train in a functional way—that is, the way that it is intended to be played with). He also imitates when she says the word “push” and he repeats it! He does this later on in the video too, repeating mom when she says the train fell “off” the table (actually Ben initiates saying “off” first when the train falls off the table, Mom then imitates him, and he imitates her back!).
In fact, several instances of social interaction occur when the train falls off the table. First, Ben seems to notice that the train has fallen off the table, and when his mom says, “uh-oh”, he turns his attention to her. He looks at her and says, “off” and then looks at the floor and back at mom. Here, Ben is initiating joint attention! Joint attention, which is sometimes falsely confused with shared attention (when two people are looking at or attending to the same object), occurs when a child gets the attention of their communication partner (usually by looking at them), directs their attention to an object or item of interest, and then looks back at the communication partner. The purpose of coordinating attention to the object is for social reasons (as opposed to making a request for that item). When Ben pushes the train off the table, says “off”, and then initiates an act of joint attention with his mom, we can almost imagine him thinking, “Hey Mom look! That train fell off the table. I pushed it, and it fell off. Oops!” The point of directing his mom’s attention to the toy in this video, presumably, is to say “look what happened!” instead of “I want you to pick the train up for me”. Finally, when Mom picks up the train and says, “Here it is”, Ben looks up from the table and coordinates his attention between his mom and the train. Ben is directing his attention to both his mother and the toy, not just the toy. He is recognizing her as part of the play activity, as opposed to just the supplier of the toys.
Now let’s contrast Ben with Nathan. Nathan is demonstrating several early signs of Autism. Despite being the exact same age as Ben, Nathan’s social interaction skills during this activity look very different. Let’s take a look at the components of social interaction that we pointed out when we talked about Ben: facial affect, initiating, imitating, combining gestures and words, and joint attention.
Unlike Ben, Nathan doesn’t appear to be interested or engaged in this particular play session with Mom. He doesn’t really smile, and it appears that he attempts to leave the table several times. Not enjoying an activity in and of itself isn’t a sign of Autism; however, the lack of social engagement here is what we want to draw your attention to.
Even though the video clip is short, Nathan does not direct his gaze to his mother at all, even when she tries to engage his attention, despite her being at eye level with him. He does not appear to look at objects that Mom is looking at (i.e., shared attention), nor does he engage in acts of joint attention (i.e., coordinating his attention between Mom and another object). Not being able to initiate or respond to acts of joint attention contributes to a difficulty socially connecting to others. Whereas Ben’s ability to coordinate his attention between his mom and the toy allowed him to non-verbally communicate that he was engaged with Mom and the play session and that he was aware that they were playing together, Nathan’s lack of joint attention may suggest that he is not engaged with or interested in playing with his mom.
Although Nathan does imitate Mom’s action once when he pushes the train back to her, he does not appear to imitate her more than that. Not imitating actions, gestures, or words impacts social development as it is by watching others and doing what they do that we learn how to navigate the world. Additionally, as we saw with Ben, imitating the actions of others (or initiating a new action) often leads to the person imitating you back, which begins a cycle of back-and-forth social connecting.
Aside from the first instance when he pushed the train back to Mom, Nathan does not play with the train in the way that it is intended to be played with. Although there is controversy around the necessity of functional play (particularly as it relates to Autism), it does appear as if Nathan is more interested in handling the train than making it move like a train. Additionally, Nathan does not use any verbal speech or communicative gestures to indicate he wants to play with his mother in this play session.
Diagnosing Autism
It is important to remember that none of the things that Nathan is (or isn’t) doing indicate, by themselves, a potential Autism diagnosis. Rather, we must take into account all of the factors affecting Nathan’s ability to socially connect with his mother. Early signs like these, however, are important to look out for if you suspect your child may have Autism. A developmental pediatrician or interprofessional team can use this information, along with specific tests, to help make or rule out an Autism diagnosis.