Does My Infant Grandson Have an Autism Spectrum Disorder?

Q. My daughter and son-in-law both work full-time, and I watch my 9-month old grandson, Caden, every day during the week. My daughter takes me with her to his doctor’s appointments, where they provide us with CDC guidelines for where he should be at his age. He seems to not be reaching his developmental milestones. I thought everything was okay and that he was just a late bloomer. As time progresses, his parents and I get more and more concerned, as their older daughter is on the Autism Spectrum. Is it possible to diagnose Autism Spectrum Disorder at such an early age, and if so is it accurate? Thanks for your help!

A. Autism Spectrum Disorder (ASD) is a developmental condition that can affect how a person behaves, interacts, and communicates. According to the Centers for Disease Control (CDC), some early indicators of ASD in babies and young children may include avoidance of eye contact, delays in language development, and limited facial expressions.

Although certain developmental delays can be concerning, you are correct that babies develop and grow at their own pace. Babies can reach developmental milestones at slightly different ages, even when they do not have any health conditions. However, some developmental differences can possibly be cause for concern and would be good to bring up with a pediatrician.

New Study Shows That Signs of ASD Can Appear as Early as 9 Months

A new study from The Society for Research in Child Development (SRCD) documents that visible social-communication differences for infants with ASD can unfold by as early as 9 months.

ASD usually is diagnosed at age 2 or 3, but relatively little is known about infants’ neurobehavior. Dr. Jessica Bradshaw, an assistant professor of psychology at the University of South Carolina who spearheaded the study, established the Early Social Development and Intervention Lab at the University of South Carolina, focused on identifying early markers of autism in infants.

According to Dr. Bradshaw, who is a strong proponent of early intervention, “We know so much about brain development in the first months of life. If we know what’s different with autism, we can identify ways to modify (a child’s) environment.”

The ultimate goal of Dr. Bradshaw’s work is to develop behavioral interventions that are both innovative and effective for children, even in the first year of their lives. She says, “We have behavioral interventions for toddlers and kids once they’re diagnosed with autism. I’m interested in interventions we might be able to implement before there is a language delay or before there are these big disparities in social communication and in social behavior. These are things that might help us tailor or modify or adapt parent-infant interaction to support social communication and social development. That’s the ultimate long-term goal.”

While there isn’t a blood test or biomarkers to identify autism in infants, Dr. Bradshaw uses assessment tools such as how a heart rate changes when an infant is interacting with a parent or with objects. For the study, she recruited three groups of infants in her lab (totaling 124 infants) including those with no family history of ASD; infants born preterm who are at greater likelihood of developing ASD; and those with an elevated genetic likelihood, meaning they have a sibling who has been diagnosed with ASD. The children are studied through the first two years of their lives.

What Are the Signs of ASD in Infants?

According to the study described, the CDC, and Autism Speaks, these are some of the signs of ASD that you might see in infants:

  • Lack of eye contact: According to Autism Speaks, “researchers describe decreases in in eye contact between two and six months of age in babies who went on to develop autism spectrum disorder (ASD). The babies actually started out with typical eye-gaze patterns. But month by month, they showed steady decreases in the amount of time they looked at a caregiver’s eyes in a video. Baby sibs who did not develop ASD showed the opposite pattern – with eye contact increasing month by month.”
  • Lack of joint attention: Joint attention refers to two people sharing a focus on the same object after one alerts the other to the item using verbal or nonverbal cues. For instance, when a parent or caregiver points to a toy or tells the child about it, the child will then look at the toy. Joint attention is an important way of connecting and interacting with other people. Babies with ASD can find it challenging to pick up on these social cues and may ignore the person or the object that they are pointing out.
  • Not responding to their name: According to the CDC, a baby should be able to respond to their name from about 6 months old. However, a 2017 study found that babies developing ASD often do not respond to their name at 9 months old.
  • Difficulty with nonverbal communication: The CDC states that from around 9 months, a baby should be able to point things out. At this age, they should also be able to copy the sounds and gestures of other people. Infants with ASD point and gesture much less than children who do not develop ASD. A lack of nonverbal communication could indicate delays in language development.
  • Limited facial expressions: By the age of four months, a person can expect a baby to be able to copy facial expressions, such as smiling or frowning. A baby should also be able to smile spontaneously and let others know if they are sad. At 6 months, a baby should recognize other people’s emotions and be able to respond to them. A baby with ASD may not respond to certain expressions or experiences with facial expressions that are inappropriate.
  • Delays in language development: By the age of 1, a child should be able to say one to three single words and try to copy words that other people say. The National Institute on Deafness and Other Communication Disorders notes that children with ASD may have trouble developing language skills and understanding what other people say. According to March of Dimes, about 40 percent of autistic children do not speak at all.
  • Regression: Regression is where a baby starts to lose skills they previously had, such as verbal communication or social behaviors. A study from 2015 found that close to one-third of children with ASD lose some skills around preschool age.

Additional Findings of the Study

Findings show that being aware of changes in social communication between 9 and 12 months can be invaluable. Abigail Delehanty, assistant professor and Program Director for the Language Disorders and Autism Clinic at Duquesne University, commented that “(i)ntervention studies for infants between 9-12 months are beginning to emerge, and this study provides a rationale for getting started supporting communication development before the first birthday, as infants with ASD exhibit fewer social-communicative behaviors and make fewer gains during this time.”

This study demonstrates that:

  • Infants who would later be diagnosed with ASD already exhibit significantly fewer social and early speech skills than their typically-developing peers at 9 months of age. However, only three months later, at 12 months, infants with ASD performed lower on nearly all measures of prelinguistic communication.
  • Three unique patterns of social-communication development emerged for infants with ASD. First, communicating with eye gaze, facial expression, and sounds were “consistently low” from 9 to 12 months;
  • The use of objects (i.e., being creative with toys), although similar across the groups at nine months, was delayed in the ASD group at 12 months;
  • Gestures and overall frequency of communication showed a “growing gap” for infants with ASD. These results suggest very early social communication differences for infants with ASD that are clear and observable as early as 9 months of age and highlight specific areas of vulnerability and unique patterns of change.

Early Intervention and Advocacy Are Very Important

Numerous studies, including the one described, have shown how impactful early intervention can be for individuals with ASD. Early diagnosis and therapeutic intervention have proven to be effective when it comes to treating symptoms of ASD.

“The first three years of life are incredibly important for an infant’s development,” Dr. Bradshaw states. “During this time, brain plasticity is at its peak. Early interventions can support the emergence of social interaction and communication skills, especially for those with an elevated likelihood of developing autism. Moreover, many of these interventions have a parent or caregiver-mediated component, meaning that parents are taught how to incorporate intervention strategies into everyday routines and interactions with their children. This is especially important in the infant and toddler years.”

If you are a parent of an autistic child, Dr. Bradshaw hopes that this study validates your concerns, no matter how early your concerns develop. She encourages parents to express concerns to their health care providers and ask to complete developmental or autism screeners (i.e., Infant Toddler Checklist, ASQ, or M-CHAT).

Planning in Advance for Children with ASD and other Special Needs

Do you have a child with ASD? If you are taking care of your child with autism or other special needs and something happened to you, what would happen to your child? A Special Needs Trust is often an essential tool to protect the financial future of an individual with special needs. Also known as a Supplemental Needs Trust, this type of trust preserves eligibility for federal and state benefits by keeping assets out of the name of the person with special needs, while still allowing the trust funds to be used to benefit the person with special needs. Learn more about Special Needs Trusts here.

When it comes to special needs planning, estate planning, and retirement planning, the attorneys at the Farr Law Firm can guide you through this process. We offer a no-cost initial consultation for potential new clients:

Special Needs Attorney Fairfax: 703-691-1888

Special Needs Attorney Fredericksburg: 540-479-1435

Special Needs Attorney Rockville: 301-519-8041

Special Needs Attorney DC: 202-587-2797

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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