1. Know the Signs

For some toddlers, the signs of autism are obvious: No language, no eye contact, obsessive-compulsive behaviors, self-injurious behavior, extreme tantrums, etc. But these are the severe cases. Such kids are actually the exception. Autism more commonly begins with more subtle signs. By educating parents and doctors about how to detect the early signs, children can be diagnosed at a younger age and intervention can begin. Dr. Bob Sears’ is an expert on autism and covers what every parent needs to know about early detection, treatment, recovery, and prevention of autism in his recent work, The Autism Book.

Here are signs you can watch for in a toddler, both obvious and more subtle, that suggest there may be a problem:

• Lack of eye contact – Babies should be quick and eager to engage a parent (and even a stranger) with focused and prolonged eye contact. And it should be spontaneous on the part of the child; a parent shouldn’t have to work to get their child to look them in the eye.
• Side glancing – Babies should look directly at people or objects. Frequently studying objects from the corner of the eyes may be a concern.
• Focus on spinning objects – Children with autism are obsessed with staring at spinning objects, such as fans or wheels.
• Lack of babbling – By seven months a baby should begin using consonant sounds, and by twelve months should be spouting off phrases of jibberish. A quiet one-year-old who is still only cooing and gooing is delayed.
• No words by eighteen months – While many late talkers won’t go on to have autism, a toddler who has not said that first “mama” or more by eighteen months warrants a full developmental evaluation.
• Solo play – Toddlers should crave and seek out play with parents and other kids. Those that prefer to play alone may have delayed social development.
• Parallel play – This refers to a toddler who likes to play alongside others, often mimicking them, but doesn’t actually play with the other kids.
• Lack of joint attention -
• Obsession with certain toys – Toddlers should be interested in engaging with a wide range of toys and objects. Those who obsess with only one or two main toys (it is often trains) may have some delay.
• Plays inappropriately with toys – Toddlers should feed their dolls, animate their stuffed animals, zoom their cars around, and bounce or roll balls back and forth. Those that line up their cars, treat their dolls or animals as simple objects, or simply look at a balls may have a concern.
• Repetitive, obsessive actions – Repeatedly turning lights on and off, opening and closing doors and drawers, or arm flapping and toe-walking can be a concern.
• Sensory aversions – Toddlers who are overly-annoyed by wearing shoes and socks or by clothing tags, can’t stand having sticky hands or a messy face, who don’t like swinging or spinning, or who are freaked out by large crowds and noisy places might have some sensory problems that are associated with autism.

Some children with autism don’t display enough obvious symptoms early on. It’s important for doctors and parents to also look for the following signs in preschoolers:

• Out-of-context language – Children should engage in back-and-forth conversation that fits in the context of a situation. If a child frequently answers questions, or spontaneously blurts out whatever’s on his mind, in ways that don’t fit the conversation, this may be a concern.
• Unusually advanced language skills – If a child is able to say the ABCs, recite nursery rhymes, list numerous famous composers, or talk incessantly about one or two primary topics in a manner that far exceeds his peers, but won’t converse about more simple and general topics, this may be a concern. It’s hard to imagine that such a brilliant child may have autism, but it’s possible.
• Answering a question with a question – If you ask a child, “What is your favorite color?” and the child answers, “What is your favorite color . . . green,” that may be a concern.
• Missing social cues – A child may understand language, but if he doesn’t pick up on sarcasm, humor, teasing, or lying, this is a concern.
• Unaware of personal space – A child with autism may hug total strangers and stand very close to other children in an unusual way.
• OCD tendencies – A child with autism may display some obsessive-compulsive behaviors, such as demanding all doors remain closed (or open), keeping food items separated on a plate, arranging toys or objects in lines, or wearing only certain clothes.

2. Detect a Problem Early

Pediatricians (myself included) used to think that it didn’t matter what age a child’s autism was diagnosed. Since there wasn’t much we could do about it, it didn’t matter if it was detected at age 1, 2, 3 or 10. We now know that the complete opposite is true. The earlier a problem is detected and the earlier intervention is started, the better the chance of recovery.

The “wait and see” approach is probably the worst thing a doctor or parent can do. Most pediatricians are probably guilty of offering this advice in the past. If a two-year-old wasn’t talking, we just blew it off with reassuring statements like “boys just talk late” or “don’t worry, he’ll pick it up soon.” If a child’s development was a bit behind, we’d tell the parents to spend more time stimulating their toddler and “we’ll see how he’s doing next year.” Now that we know how critical early treatment is, pediatricians and parents should act right away.

There are two keys to early detection: Parental awareness and formal pediatrician screening tests. Screening tests have been developed for pediatricians to perform at every child’s eighteen-month and two-year check ups. These tests are designed to detect at-risk children so that further developmental testing can be done for those who need it. There are also some screening tests for older kids who may have some delays in their social and language skills that could be missed on earlier screens.

The most popular autism screening test is called a CHAT (Checklist for Autism in Toddlers). The first part of the CHAT comprises nine developmental questions that are answered by the parent to make sure a toddler is meeting all the usual milestones. These include enjoying swinging or bouncing, showing interest in other kids, climbing, playing peek-a-boo, engaging in pretend play, pointing with the index finger, playing correctly with toys, and bringing objects to show the parent. The second part of the test involves the pediatrician’s observations, in which the doctor will make sure the child makes sustained eye contact, shows interest in something when the doctor points, plays appropriately with a toy cup or doll, points at something that the doctors asks about, and stack some blocks.

There are several other types of screening tests your doctor can choose from, but it is important that he or she performs some type of formal autism screening test. It isn’t enough to simply ask a mom if she thinks there are any developmental problems. Autism can begin with very subtle signs, and a first-time parent may not notice things that formal screening test will pick up.

I’ll be honest. As a pediatrician it’s not always easy to spot a toddler with autism early on. A doctor’s office doesn’t always bring out the best in a toddler’s behavior, and there isn’t always enough time to do a thorough developmental check. We have to partly rely on a parent’s own skills of observation. Pediatric care is a partnership between the parents and the doctor, and by working together we can better detect toddlers with early signs of a problem.

3. Begin Intervention at the Earliest Possible Age

The single most important thing for every parent to know is that developmental therapy should begin as soon as a significant developmental problem is suspected. Parents should absolutely not wait until a diagnosis of autism is confirmed. Here is why. Most children who end up being diagnosed with autism don’t meet all the criteria until at least age two, and often not until three or older. But the autistic symptoms may be noticed as early as one year of age or even younger. Some parents will waste a year or more seeking various developmental evaluations, seeing numerous medical specialists, and getting second opinions, without actually initiating any meaningful therapy. If a parent waits until their child is ultimately diagnosed with autism before actually doing anything about it, they’ve likely wasted a year or more of potential therapeutic time. We know that the younger the therapy is started, the better it works.

My advice to every parent who suspects there might be a problem is this: While getting a full developmental and neurological evaluation, begin developmental therapies at the same time. It may be challenging to obtain developmental therapeutic services before a child is formally diagnosed with autism, but if a toddler isn’t speaking, begin language therapy. If his eye contact and social interaction are delayed, begin developmental stimulation therapy. If he is showing some sensory aversions, begin sensory integration OT (see below). If he’s showing some early classic signs of autism, start some ABA therapy (see below). All of these can be started before a diagnosis is made.

I have (tragically) seen some families wait a year or more before beginning these treatments because they weren’t sure if their child definitely had autism. In my opinion, any child with early subtle signs is at risk of eventually developing full autism. Start therapy early.

4. Choose the Right Therapies

There are four basic branches of therapy that every child with suspected or confirmed autism should begin:

• Applied Behavioral Analysis – ABA therapy is the backbone of autism treatment. A child will typically spend two to six hours each day, five days per week, with a licensed ABA therapist. The approach utilizes behavioral techniques to teach a child with autism how to behave, interact, and socialize.
• Speech and language therapy – A speech pathologist will spend between one and four hours per week with a child working specifically on language skills.
• Occupational therapy – This therapist will spend a few hours each week working on a child’s movement, coordination, and strength skills. Sensory Integration Therapy (a branch of OT) should also be done to help teach a child how to understand and handle sensations.
• Social skills therapy – There are various one-on-one or group approaches to teaching children how to socialize and interact with other kids. Preschoolers and older should be in such a class at least once a week.

A therapy program needs to be tailored to a child’s individual needs. One child may need more hours of language therapy, whereas another may need more sensory OT. And there are many variations of the above therapies. Parents should seek the advice of an experienced developmental case manager to help guide their child’s program.

There are two ways to seek therapy. The first is through a state-funded program, which you should be able to find through your pediatrician. A case manager will meet with you and your child for some initial screening tests. Then your child will have a full developmental evaluation to determine what therapies he will qualify for. These will then be started. These therapists probably won’t determine whether or not your child actually has autism. They will simply get started on therapies to address the delays he has. The state program will refer you to a developmental pediatrician, psychologist, or neurologist to further assess the possibility of autism. But meanwhile, your child will start the much-needed therapies. If your child eventually does receive the diagnosis of autism, he will likely qualify for expanded therapies which will likely comprise six to eight hours each day, five days per week.

Parents also have the option of seeking private developmental therapies, either through their insurance or paying out of pocket. There are numerous autism therapy centers in almost every major city. You may have to fight with your insurance company to get things covered, but most states have now passed laws that require insurance to cover autism treatments.

5. Explore Biomedical Interventions

Besides addressing the developmental challenges of autism, it is equally important to treat any associated medical problems that may be contributing to your child’s autism. There are various medical, nutritional, allergic, and infectious problems that can possibly make autistic symptoms and behaviors worse. These vary greatly between children. It’s useful to seek out a pediatrician or other health care practitioner who has taken a special interest in autism treatment. Here are several of the main medical issues that should be addressed:

• Chronic intestinal problems – Although many children with autism don’t seem to have any symptoms of diarrhea or constipation, those that do can benefit greatly from having their gut healed and returned to normal function. A doctor can test your child for food allergies or intestinal infections that may be contributing to this. There is a direct connection between the intestinal system and overall neurological function. Healing the gut can help heal the brain.
• Allergies – Eczema, nasal allergies, asthma, or food allergies can all interfere with the immune system. It’s important to test for these and eliminate or treat any offending allergens. A healthy immune system helps improve neurological function.
• Thyroid problems – A poorly functioning thyroid gland is somewhat common in autism. This can be easily diagnosed with a blood test.
• Metabolic disorders – There are a host of rare metabolic problems that a child with autism may have. Some are treatable, some are not. A doctor can test for these.
• Genetic disorders – Rarely, a child’s autism will be caused by a major genetic defect, such as Fragile X syndrome. Genetic testing can be done to look for such problems, although there is no specific treatment (yet) if a genetic disorder is found.

These are just a few of the possibilities. There are many more medical issues that an autism specialist can look for.

Besides looking for and treating the various medical problems, there are numerous nutritional treatments that I have found to be very effective in some children. Such therapies do not help everyone, but they are harmless and are based upon solid scientific and nutritional principles. Here are some of the basics that I try with my own patients:

• Multivitamin/mineral supplements – Children with autism and digestive problems can have some nutritional deficiencies, so I like to make sure they are covered. I like to use products that are high in B-complex vitamins, especially B-6, as this has been shown to improve neurological function.
• Fish oil – Omega-3 oils are critical to normal neurological function, and supplementing has been shown to help a whole host of medical conditions.
• Probiotics – These healthy bacteria are essential for normal intestinal function. They are especially important for any child with chronic diarrhea or constipation.
• Other nutrients – There is a whole variety of other nutritional treatments that doctors who treat autism like to try. Your doctor will be able to offer you more guidance.

6. Join a Parent Support Group

You are not alone. There are hundreds, if not thousands, of other families in every major city who have already gone through the same thing you are. Seek their help. They’ve learned who the best local therapists are, how the local school district works, how an insurance company covers therapy, what local doctors are in your area who can really help, and much more. Trying to figure out what to do on your own is like stumbling around in the dark. Let other veteran parents help you find your way.

Numerous groups have been established across the country to offer help to families with autism. Some focus on education and diagnosis, some provide lists of autism medical providers and behavioral/developmental therapists, some offer financial assistance to needy families to help cover therapy, and some focus on political action. Some only provide mainstream information and others incorporate biomedical interventions. I have interacted with a number of these groups and have been thrilled with how much help they can provide families.

My favorite group is Talk About Curing Autism. TACA covers pretty much everything, and they have physical chapters in 17 states so far (and they continue to grow every year). They can also help families living in states that don’t yet have an outreach chapter.  TACA provides families with hands-on assistance (both in group meetings and one-on-one) to help parents understand everything they can do for their child. They provide biomedical diet and supplement education, resource lists of behavioral and developmental therapists, lists of doctors who specialize in autism, social functions for families affected by or involved with autism, marriage counseling for parents, financial support for families in need, and online support from educated and experienced parents to answer questions directly. They also have resources in Spanish. And best of all they have an autism mentor program that will match any newly diagnosed family with another family who has been working through autism for several years and knows how to help you get the most out of the resources in your area. Visit www.TACAnow.org today. You can’t do this alone. The help and support of other parents is crucial to you, your child, and your family.

7. Use Trusted Sources of Information

Be sure to research and become educated about any unproven alternative therapies before trying them. While many are natural and harmless, some do pose risk. Parents should make sure they feel comfortable and confident with what they are trying before they do it.

There are many alternative therapies that doctors all over the world are trying, with varying degrees of success. I have been exploring such treatments over the past ten years, and my experience and advice has culminated in The Autism Book: What Every Parent Needs to Know About Early Detection, Treatment, Recovery, and Prevention. There is so much to learn about this escalating disorder. There are many exciting new treatments. In The Autism Book, I guide you through all your options, including the diagnosis, exploring all possible causes, putting together the right developmental treatment program, and treating your child with safe and natural medical and nutritional supplements. And most important of all, I discuss preventive measures new parents can take with their first baby (and affected families can take with their next children) to reduce the risk of autism. There are many environmental, genetic, medical, and nutritional factors involved in autism. Understanding these is critical to prevention.

Dr. Bob Sears is a father of three, pediatrician, author and is part of the Sears Family of Pediatricians. Dr. Bob received his medical degree from Georgetown University School of Medicine and did his pediatric training at Childrens Hospital Los Angeles. He practices in Dana Point, California.