Early Signs of Autism: A Different Perspective

I am thrilled to feature this guest post by Megan Myatt, M.S., CCC-SLP, speech-language pathologist and owner of a speech-language pathologist and owner of Growing Together: Speech-Language Therapy. She provides speech-language evaluations and therapeutic supports for young children and their families in Carroll County, Maryland. www.growtogetherslp.com

In honor of Autism Acceptance Month, and in anticipation of Better Language and Communication Month, I’d like to talk about the benefits of early identification (and resulting therapeutic supports) of autism. But first, let’s go over a few definitions...

What is autism? 

The DSM-5 defines autism as “persistent deficits in social communication and social interaction” paired with “restricted, repetitive patterns of behavior, interests, or activities” that cannot be better explained by other disorders/disabilities (e.g., intellectual disability).  

While this definition provides specific insight into the social and behavioral presentation of autism, I find it to be somewhat negative. It implies that autistic individuals have “deficits” or “atypical behaviors,” when really, they’re just wired differently. 

Over the years, I’ve noticed that some parents (definitely not all) avoid early identification, or quickly seek to change their child’s “deficits,” in fear of what they perceive autism to be. 

As a parent of an autistic child, I completely understand this fear. Our society has long supported the notion that autism is a bad thing. The media presents only the best and worst parts of autism. Parents want the best for their children- whether that be love, acceptance, happiness, you name it, and autism may be viewed as a barrier to those experiences. 

So let’s talk about another definition: 

What is ableism? 

Ableism is defined as the “discrimination and social prejudice against people with disabilities and/or people who are perceived to be disabled. Ableism characterizes people who are defined by their disabilities as inferior to the non-disabled.”

The diagnostic criteria for autism is clearly written from an ableist perspective. And it’s time to shift our language and views to celebrate and embrace the differences that autistic individuals have to offer. This change is not going to happen overnight, but I believe it starts with the early identification/diagnostic process. 

I propose the idea of using different, strengths-based language to talk about autism. Limiting words like “deficits,” “impairments,” “atypical,” or “odd.” As professionals and/or parents, we can still acknowledge our child’s social, communication, and behavioral challenges, and leave out the ableist terminology. 

So- back to the main topic: are you concerned about your child’s development? Do you notice differences in their communication, social interaction, play, and behavior? Here are some early characteristics or traits of autism (Please note- this is not an all-inclusive list, and not all traits are necessary for an autism diagnosis): 

• Differences in language and communication

  • May demonstrate challenges with verbal communication (e.g., may not use words, or may repeat phrases)

  • May prefers physical communication (e.g., pulling/guiding)

  • May use fewer communicative gestures (e.g., pointing)

  • May not always respond to their name

• Differences in social communication

• May prefer to be the leader in their own play (i.e., may play next to other children rather than with them)

• May show differences in social reciprocity (e.g., may not understand the social expectation of responding to hello/goodbye)

• May demonstrate differences in gaze/eye contact and facial expressions (e.g., may not give everyone eye contact)

• May not show and share interests as expected (e.g., pointing out interesting toys, sharing objects for play)

• Differences in play and behavior

• May find different ways to play/use objects (e.g., aligning toys)

• May be detail-oriented (e.g., notices blemishes on preferred toys)

• May prefer repetition and routine

• May demonstrate special interests in certain topics or objects 

• May have different sensory experiences (e.g., sensitive to lights or loud noises) 

• May express emotions in physical ways (e.g., flapping hands)

So, what’s the benefit of early identification/diagnosis?

Early identification leads to early intervention, which can provide your child with the opportunity to build engagement and connections with others, grow their communication skills to advocate for their wants, needs, and interests, and begin to learn how to regulate their emotions and sensory experiences in this world. 

It also provides answers- for parents, families, etc. Early identification may lead to a greater understanding of autism- helping parents to understand their child, communicate with them, understand their behaviors and meet their sensory/emotional needs, and connect on a deeper level.  

The risk of “wait and see” and/or the fear of diagnosis plays into the ableist perspective. It may also prolong communication challenges for autistic children- particularly in a world that wasn’t designed for them (at present time). Autism does not have to be negative, and it does not need to be “fixed.” Early interventionists can identify and foster your child’s strengths, and support your family in meaningful ways. 

If you’ve noticed any of the above signs/traits of autism, reach out to your local early intervention program or related professionals. And remember, acceptance starts with you. Neurodiversity is beautiful. 

Applied Behavior Analysis (ABA) and Speech Therapy: What's the Difference?

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Guest post! Alyssa Gilligan, M.S. CCC-SLP is a speech-language pathologist specializing in the treatment of children with Autism. She works at an ABA center in Hunt Valley, Maryland and works very closely with the ABA team!

"Applied Behavior Analysis (ABA) is an intervention strategy commonly used with children with Autism Spectrum Disorder. ABA involves the use of research proven, behavior based strategies to teach communication, life skills, social skills, and academics. It focuses on the principles of motivation and reinforcement to increase positive behaviors and decrease negative behaviors.

An ABA program is developed by a Board Certified Behavior Analyst (BCBA) who supervises a Registered Behavior Technician (RBT) that works with the child under the direct supervision of the BCBA. The program development is based on detailed analysis of data collected by the RBT and goals are added and modified based on that data!

ABA and speech-language therapy have a lot in common. An SLP and a BCBA working together can make miracles happen! The SLP provides knowledge and expertise of developmental milestones that assist the BCBA in developing new goals. For example, providing education on which grammatical markers the child should be using, knowing what play skill the child needs to learn next, or knowing at what stage of narrative language the child is. Alternatively, the BCBA can assist the SLP in identifying motivators and developing custom reinforcement systems to increase the child's participation in therapy.

ABA is also excellent at helping with generalization! The SLP might teach a new skill to a student but may not have the opportunity to work on it outside of the therapy room. The BCBA would then make similar goals and practice the skill in the natural environment.

In short, ABA and speech make a really powerful team!"

Alyssa S. Gilligan, M.S. CCC-SLP

Parents: You Know Best

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Missing early language milestones is one of the first observable signs leading to parent concern about their child’s development. Parents are often comforted by well-intentioned friends, family and (unfortunately,) healthcare professionals to “wait and see if they grow out of it.” There will always be a story, intended to ease parental nerves, of a neighbor’s cousin’s friend’s son who didn’t speak a word “until they were 4” and now is totally fine! He never needed speech therapy or anything special, so I’m sure your child won’t either.

As a parent, trust your gut. Know the signs, and push for a referral from your pediatrician, even if your concerns are being dismissed. One study from the University of Oregon found that a simple 15-minute parent questionnaire submitted before or after a doctor's appointment resulted in a 224-percent increase in referrals of one-year-old and two-year-old children with mild developmental delays in a yearlong study. This means that without parent input, 53 of 78 referrals would not have been made by the pediatrician’s observations alone. The study also indicated that physicians had a greater difficulty identifying delays at 12 months compared to 24 months. Neural circuits in the brain, which create the foundation for learning, behavior and health, are most flexible (or able to be molded,) during the first 3 years of life. Missed signs between 12 and 24 months equates to 1 whole year (excluding any potential wait lists,) without early intervention services, which over 40 years of research has shown to be crucial to short and long term gains.

The bottom line is, always air on the side of caution and ask for a referral, regardless of the opinion of others… even your pediatrician. You are the expert on your child!

Here are a few myths associated with Early Intervention (EI):

• Therapy is too expensive: From birth to three years old, your child qualifies for free early intervention evaluations and services, in every state in the U.S. Here is a list of early intervention providers by state. You don’t need to wait for a referral from your doctor for an evaluation with EI- go ahead and call today! EI can be provided in-home or in an outpatient center, depending on your location. You may choose to add additional private therapy depending on your child’s needs.

• My child is over 3 years old, it’s too late: For children who have not received EI by 3 years old, contact the Child Find program through your local public school system (google “Child Find“ and your state). Children ages 3-21 with suspected delays are entitled to free evaluations and services through the school system. You may choose to add additional private therapy depending on your child’s needs. You can find local speech therapists in your area using the American Speech-Language Hearing Association (ASHA)’s ProFind Tool: www.asha.org/profind/

• My child attends private school; they don’t have therapists there: Even if your child attends a private school, they are still entitled to a free evaluation and services through Child Find. A speech-language pathologist from the public school system where your child’s private school is located can push-in to your child’s school to deliver services. You may choose to add additional private therapy depending on your child’s needs (See above for links for a previous post on school/private services and to find local therapists)

• I have concerns for Autism; EI or Child Find is enough: Though EI and Child Find can assess for Autism through a multidisciplinary evaluation with a psychologist, an educational classification of Autism is not the same as a medical diagnosis. If your child is identified as having Autism through EI or Child Find, it will entitle them to services within school; it will not cover private services through your insurance company. The National Research Council has determined that a minimum of 25 hours per week of early, intensive intervention is best practice for children with Autism; this means that a combination of school and private services is usually the best bet for long term gains. If you have concerns regarding Autism, contact an Autism Center in your area for a multidisciplinary evaluation; because Autism is a large “spectrum,” disorder (meaning it presents in different ways, with varying degrees of severity,) it’s important to see specialists when determining an Autism diagnosis. If you’re unsure if you have concerns about Autism, check out the following resources:

• Parent Questionnaire that assesses for level of concern for autism (M-CHAT)

• Videos comparing typical play development in toddlers vs. toddlers with Autism

• Additional developmental milestone information

The moral of the story is: you, as a parent, are your child’s best advocate. Pushing for referrals early on may feel overly cautious; however, research shows that the earlier the intervention, the greater the outcomes. In terms of your child’s development, it is always better to be safe than sorry. Trust your gut, know the signs, act early, and keep rocking parenthood!

Jackie

Echolalia and Jargon: Defined

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First of all, what are echolalia and jargon?!

These terms are often thrown around when talking about early development, but not always clearly explained.

Echolalia ("echo-lehl-ee-yuh"): repeating others' words and phrases with the same intonation and inflection. Echolalia can be immediate, (imitating what you say or ask,) or delayed (this is also sometimes called "scripting," and refers to repeating lines from T.V. shows, videos, or previously heard language repetitively). Here's an example of echolalia.

When echoing, children may be able to produce language that is more complex than what they are able to use functionally. Parents often (understandably,) express confusion about this when asked how their child communicates; "My child can speak in sentences...but it's only ever things he's heard before, and not all the time." For example, children may produce 3-5 word sentences that they've heard before, or sing songs in their entirety, but are unable or have significant difficulty using their own words spontaneously to express their wants and needs in an age appropriate way ("juice" or "I want some juice," to request). This tells us that though these children are able to repeat language they hear, (with an impressive amount of memory and mimicry!) they are not fully understanding the words as individual units that can be combined to communicate with others.

Jargon: strings of vowels and consonants with conversational intonation, without or with minimal production of meaningful words. Sometimes this sounds like, "bhjfblsdkhf mama fhdiskdf!!" :) The recent viral video of that adorable baby having a "conversation," with his father is a great example of jargon (if you haven't already watched it, you're welcome!)

What's "typical"?

Echolalia: Some echolalia is typical starting around 1 year, 6 months of age. Your child is actively absorbing language from their environment; you might hear them repeat your language as they are learning new words or concepts. For example, they may seem really interested in a new snack choice. You say, “These are grapes!” Child says, “Grapes!!” excitedly. Your child is repeating your words because they’re attributing it to this new object of interest. At this stage, your child should still be producing their own, non-echoed language in the majority of cases.

The occasional use of echolalia is usually eliminated by age 3. When a child produces primarily jargon and the majority or entirety of their intelligible language is echoed from others, it can be considered a red flag for developmental disorders, including Autism Spectrum Disorder, (otherwise known as "Autism," or "ASD"). Though echolalia is not the sole diagnostic indicator of ASD, research has found that up to 85% of verbal children with Autism exhibit echolalia in some form. There will be future posts on early warning signs of ASD, but in the mean time, here are videos and explanations of other "Red Flag," behaviors indicating concerns for Autism.

Jargon: Between 1 and 1 year, 6 months old, children produce jargon frequently! They are observing our inflection patterns, and attempting to participate in the conversation. The use of jargon should be eliminated by age 2. By 2 years old, your child should produce more novel (non-echoed,) words than jargon, and speak with about 50% intelligibility.

How do we help?

Echolalia: When a child is repeating your language frequently, avoid asking questions. Your child repeating what you’re asking is a sign that they a) don’t understand what you’re asking and/or b) don’t have the language to give you a response just yet! Repeating the questions repetitively often results in frustration… for the child and the parents! Here are some specific recommendations based on situation and type of echolalia you may be seeing:

*Avoid telling your chid, "Say ____." Your child will, inevitably do exactly what you ask.. and say, "Say, hi!" or "Say, bye bye!" It's best to model language exactly as your child would say it ("Hi, Mom!" "Want more snack.")

*Instead of asking questions, try leading with the answers. Consider: “Truck!” instead of “What is it?” when reading a book, “I’m eating!” instead of “What are you doing?” “I’m sad.” Instead of “Why are you crying?”

*If your child is repeating your language when they are sad or hurt, ("You're okay," while crying, "It's okay, come to Mommy!" when scared,) model language for them that fits the situation ("I fell down," "I hurt my hand," "I'm okay," "I'm scared")

*If your child is scripting language, and using it functionally ("Oh no! What will we do?" when something breaks,) offer a more flexible model ("The car broke. I need help.")

If your child tends to use the same phrase every time when requesting (“I want ____,” or “____, please,”) model different ways they can ask! Try things like “More ___, please!” or “Can I have ___?”

Jargon: The most important thing is to respond to your child's productions! Just as our rock star Dad did in the viral conversation video, responding to your child when they produce jargon is a crucial step in their development; you are teaching them reciprocity and encouraging engagement. If your child is producing jargon and is giving you a clear indication of what they are interested in or are trying to say, say it for them! For example, your child reaching towards bubbles and producing jargon while looking at you. Model, “Bubbles!” or “Want bubbles!” for them before engaging in the bubble activity. Repeat this model and then start to pause to allow your child the opportunity to fill in!

Happy Chatting!

Jackie